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General NPI Number Information
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NPI Number | 1881830040
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Entity Type | Organization
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Legal Business Name | VALLEY INTERVENTIONAL PAIN MEDICAL GRP
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Dates
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Enumeration Date | 12/18/2008
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Last Update Date | 03/19/2015
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Provider Practice Location Address
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Address Line | 1524 MCHENRY AVE #445
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City | MODESTO
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State | CA
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Zip | 95350
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Country | US
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Telephone | 209-571-1693
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Fax | 209-571-0326
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Provider Business Mailing Address
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Address Line | 1524 MCHENRY AVE. #445
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City | MODESTO
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State | CA
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Zip | 95350
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Country | US
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Telephone | 209-571-1693
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Fax | 209-571-0326
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Authorized Official
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Title or Position | OWNER
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Name | DR. JAMES E BARNETT
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Credential | MD
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Telephone | 209-571-1693
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 05D1086032
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License Number State | CA
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