=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942294327
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CENTRAL VALLEY URGENT CARE MEDICAL GROUP INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/31/2005
-----------------------------------------------------
Last Update Date | 10/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 199 W SHIELDS AVE
-----------------------------------------------------
City | FRESNO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93705-4102
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-225-4706
-----------------------------------------------------
Fax | 559-225-4710
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 199 W SHIELDS AVE
-----------------------------------------------------
City | FRESNO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93705-4102
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-225-4706
-----------------------------------------------------
Fax | 559-225-4710
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | MR. GILBERT DANIEL BUSTOS
-----------------------------------------------------
Credential | AO
-----------------------------------------------------
Telephone | 559-225-4706
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------