Provider Demographics
NPI:1114212685
Name:CITRUS VALLEY PHYSICIANS GROUP
Entity Type:Organization
Organization Name:CITRUS VALLEY PHYSICIANS GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE ASSISTANT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAJESH
Authorized Official - Middle Name:
Authorized Official - Last Name:RAO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-474-6999
Mailing Address - Street 1:43 CORPORATE PARK
Mailing Address - Street 2:SUITE 206
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92606-5137
Mailing Address - Country:US
Mailing Address - Phone:949-474-6999
Mailing Address - Fax:949-474-6997
Practice Address - Street 1:43 CORPORATE PARK
Practice Address - Street 2:SUITE 206
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92606-5137
Practice Address - Country:US
Practice Address - Phone:949-474-6999
Practice Address - Fax:949-474-6997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-13
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization