Provider Demographics
NPI:1093046278
Name:CENTRAL VALLEY MEDICAL SUPPLIES
Entity Type:Organization
Organization Name:CENTRAL VALLEY MEDICAL SUPPLIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NATALIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:CORRAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-283-9670
Mailing Address - Street 1:1731 W BULLARD AVE STE 128
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-2369
Mailing Address - Country:US
Mailing Address - Phone:559-478-4210
Mailing Address - Fax:559-412-4119
Practice Address - Street 1:1731 W BULLARD AVE STE 128
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-2369
Practice Address - Country:US
Practice Address - Phone:559-478-4691
Practice Address - Fax:559-412-4119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-27
Last Update Date:2012-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6411800001Medicare NSC