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NPI Code Detail

MEDICARE: CENTRAL VALLEY URGENT CARE MEDICAL GROUP INC

MEDICARE: CENTRAL VALLEY URGENT CARE 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
1207Q00000XFamily Medicine Physician

General Provider Information

NPI Number : 1942294327
Entity Type Code : Organization
Provider Name (Legal Business Name) : CENTRAL VALLEY URGENT CARE MEDICAL GROUP INC
Provider Business Mailing Address
First Line : 199 W SHIELDS AVE
Second Line :
City : FRESNO
State : CA
Zip : 93705-4102
Country : US
Telephone Number : 559-225-4706
Fax Number : 559-225-4710
Provider Business Practice Location Address
First Line : 199 W SHIELDS AVE
Second Line :
City : FRESNO
State : CA
Zip : 93705-4102
Country : US
Telephone Number : 559-225-4706
Fax Number : 559-225-4710
Authorized Official
Title or Position : MANAGER
Name : MR. GILBERT DANIEL BUSTOS
Credential : AO
Telephone Number : 559-225-4706
Provider Enumeration Date : 08/31/2005
Last Update Date : 10/10/2025

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