=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861847170
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADVANCED CENTRAL VALLEY VASCULAR INSTITUTE, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/25/2016
-----------------------------------------------------
Last Update Date | 04/25/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3550 Q ST SUITE 205
-----------------------------------------------------
City | BAKERSFIELD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93301-1662
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-321-9767
-----------------------------------------------------
Fax | 661-321-9747
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3550 Q ST SUITE 205
-----------------------------------------------------
City | BAKERSFIELD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93301-1662
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-321-9767
-----------------------------------------------------
Fax | 661-321-9747
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN
-----------------------------------------------------
Name | DR. MUHAMMAD CHAUDHRI
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 559-627-0112
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM2500X
-----------------------------------------------------
Taxonomy Name | Medical Specialty Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QR0207X
-----------------------------------------------------
Taxonomy Name | Mobile Mammography Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 261QR0200X
-----------------------------------------------------
Taxonomy Name | Radiology Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------