Provider Demographics
NPI:1235477597
Name:SOUTH VALLEY PRIMARY CARE GROUP
Entity Type:Organization
Organization Name:SOUTH VALLEY PRIMARY CARE GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SMITHA
Authorized Official - Middle Name:
Authorized Official - Last Name:KUMAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:831-676-6766
Mailing Address - Street 1:9460 N NAME UNO
Mailing Address - Street 2:SUITE 110
Mailing Address - City:GILROY
Mailing Address - State:CA
Mailing Address - Zip Code:95020-3537
Mailing Address - Country:US
Mailing Address - Phone:831-676-6766
Mailing Address - Fax:
Practice Address - Street 1:9460 N NAME UNO
Practice Address - Street 2:SUITE 110
Practice Address - City:GILROY
Practice Address - State:CA
Practice Address - Zip Code:95020-3537
Practice Address - Country:US
Practice Address - Phone:831-676-6766
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-22
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty