MEDICARE: SUCCESS VALLEY MEDICAL GROUP, INC

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	2086S0129X	Vascular Surgery Physician	A21821	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548487580
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUCCESS VALLEY MEDICAL GROUP, INC

Provider Business Mailing Address
First Line	:	53 E CLEVELAND AVE
Second Line	:
City	:	PORTERVILLE
State	:	CA
Zip	:	93257-3748
Country	:	US
Telephone Number	:	559-781-6323
Fax Number	:	559-781-7290

Provider Business Practice Location Address
First Line	:	53 E CLEVELAND AVE
Second Line	:
City	:	PORTERVILLE
State	:	CA
Zip	:	93257-3748
Country	:	US
Telephone Number	:	559-781-6323
Fax Number	:	559-781-7290

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. HUGO RENE ESCOBAR
Credential	:	M.D.
Telephone Number	:	559-781-6323

Provider Enumeration Date	:	04/19/2007
Last Update Date	:	08/22/2020

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Directions to “SUCCESS VALLEY MEDICAL GROUP, INC ” Practice Location

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