MEDICARE: CENTRAL VALLEY PULMONARY DIAGNOSTICS, LLC

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
1	293D00000X	Physiological Laboratory	RCP5561	CA

General Provider Information

NPI Number	:	1073835856
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRAL VALLEY PULMONARY DIAGNOSTICS, LLC

Provider Business Mailing Address
First Line	:	7210 N MILBURN AVE
Second Line	:	SUITE 105
City	:	FRESNO
State	:	CA
Zip	:	93722-8448
Country	:	US
Telephone Number	:	559-451-3460
Fax Number	:	559-341-3462

Provider Business Practice Location Address
First Line	:	7210 N MILBURN AVE
Second Line	:	SUITE 105
City	:	FRESNO
State	:	CA
Zip	:	93722-8448
Country	:	US
Telephone Number	:	559-451-3460
Fax Number	:	559-341-3462

Authorized Official
Title or Position	:	MANAGING OFFICER
Name	:	JERRY O ESPEJO
Credential	:	RCP
Telephone Number	:	510-717-7601

Provider Enumeration Date	:	02/22/2010
Last Update Date	:	05/10/2013

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