Provider Demographics
NPI:1033787239
Name:VALLEY HYPERBARIC CENTER INC
Entity Type:Organization
Organization Name:VALLEY HYPERBARIC CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SIRAJ
Authorized Official - Middle Name:K
Authorized Official - Last Name:AHMED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-823-2131
Mailing Address - Street 1:1112 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MANTECA
Mailing Address - State:CA
Mailing Address - Zip Code:95336-3208
Mailing Address - Country:US
Mailing Address - Phone:209-823-2131
Mailing Address - Fax:
Practice Address - Street 1:333 SUNRISE AVE STE 890
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3482
Practice Address - Country:US
Practice Address - Phone:916-771-2555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-14
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA138466OtherCA LICENSE