Provider Demographics
NPI:1144572553
Name:CENTRAL VALLEY CARDIOVASCULAR ASSOCIATES INC
Entity Type:Organization
Organization Name:CENTRAL VALLEY CARDIOVASCULAR ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VENKATA
Authorized Official - Middle Name:
Authorized Official - Last Name:EMANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-465-0123
Mailing Address - Street 1:PO BOX 7065
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95267-0065
Mailing Address - Country:US
Mailing Address - Phone:209-942-1005
Mailing Address - Fax:209-239-7842
Practice Address - Street 1:1148 NORMAN DR
Practice Address - Street 2:SUITE 2
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95336-5961
Practice Address - Country:US
Practice Address - Phone:209-942-1005
Practice Address - Fax:209-239-7842
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-09
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA80313207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR652AMedicare UPIN