Provider Demographics
NPI:1073835856
Name:CENTRAL VALLEY PULMONARY DIAGNOSTICS, LLC
Entity Type:Organization
Organization Name:CENTRAL VALLEY PULMONARY DIAGNOSTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:O
Authorized Official - Last Name:ESPEJO
Authorized Official - Suffix:
Authorized Official - Credentials:RCP
Authorized Official - Phone:510-717-7601
Mailing Address - Street 1:7210 N MILBURN AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93722-8448
Mailing Address - Country:US
Mailing Address - Phone:559-451-3460
Mailing Address - Fax:559-341-3462
Practice Address - Street 1:7210 N MILBURN AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93722-8448
Practice Address - Country:US
Practice Address - Phone:559-451-3460
Practice Address - Fax:559-341-3462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-22
Last Update Date:2013-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARCP5561293D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory