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General NPI Number Information
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NPI Number | 1881703593
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Entity Type | Organization
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Legal Business Name | PORTERVILLE VALLEY PROMPTCARE MEDICAL
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Dates
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Enumeration Date | 08/29/2006
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Last Update Date | 06/02/2010
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Provider Practice Location Address
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Address Line | 876 W GRAND AVE
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City | PORTERVILLE
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State | CA
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Zip | 93257-2071
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Country | US
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Telephone | 559-781-3014
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Fax | 559-781-4296
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Provider Business Mailing Address
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Address Line | 876 W GRAND AVE
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City | PORTERVILLE
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State | CA
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Zip | 93257-2071
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Country | US
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Telephone | 559-781-3014
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Fax | 559-781-4296
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DWIGHT JAMES
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Credential | M.D.
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Telephone | 559-781-3014
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | G40223
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License Number State | CA
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