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NPI Code Detail

MEDICARE: CENTRAL VALLEY OCCUPATIONAL MEDICAL GROUP

MEDICARE: CENTRAL VALLEY OCCUPATIONAL MEDICAL GROUP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1204C00000XSports Medicine (Neuromusculoskeletal Medicine) PhysicianA31892CA

General Provider Information

NPI Number : 1033146998
Entity Type Code : Organization
Provider Name (Legal Business Name) : CENTRAL VALLEY OCCUPATIONAL MEDICAL GROUP
Provider Business Mailing Address
First Line : 4100 TRUXTUN AVE STE 200
Second Line :
City : BAKERSFIELD
State : CA
Zip : 93309-0656
Country : US
Telephone Number : 661-632-1540
Fax Number : 661-632-1538
Provider Business Practice Location Address
First Line : 4100 TRUXTUN AVE STE 200
Second Line :
City : BAKERSFIELD
State : CA
Zip : 93309-0656
Country : US
Telephone Number : 661-632-1540
Fax Number : 661-632-1538
Authorized Official
Title or Position : ADMINISTRATIVE MANAGER
Name : MRS. ALEJANDRA BENAVIDES
Credential :
Telephone Number : 661-632-1540
Provider Enumeration Date : 06/27/2006
Last Update Date : 08/22/2020

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