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General NPI Number Information
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NPI Number | 1962750224
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Entity Type | Organization
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Legal Business Name | CENTRAL VALLEY CARDIOVASCULAR MEDICAL GROUP, INC
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Dates
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Enumeration Date | 08/16/2012
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Last Update Date | 03/24/2025
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Provider Practice Location Address
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Address Line | 1508 COLORADO AVE
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City | TURLOCK
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State | CA
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Zip | 95380-2711
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Country | US
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Telephone | 209-668-8030
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Fax | 209-668-8031
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Provider Business Mailing Address
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Address Line | PO BOX 4978
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City | MODESTO
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State | CA
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Zip | 95352-4978
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Country | US
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Telephone | 209-575-4575
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Fax | 209-575-4598
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Authorized Official
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Title or Position | CEO
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Name | DR. REZA NAZARI
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Credential | M.D.
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Telephone | 209-602-6684
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 40507
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License Number State | CA
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