Provider Demographics
NPI:1295358067
Name:CAL CENTRAL MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:CAL CENTRAL MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PENUNURI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-697-9954
Mailing Address - Street 1:204 N K ST
Mailing Address - Street 2:
Mailing Address - City:DINUBA
Mailing Address - State:CA
Mailing Address - Zip Code:93618-1926
Mailing Address - Country:US
Mailing Address - Phone:559-596-5107
Mailing Address - Fax:559-596-5108
Practice Address - Street 1:204 N K ST
Practice Address - Street 2:
Practice Address - City:DINUBA
Practice Address - State:CA
Practice Address - Zip Code:93618-1926
Practice Address - Country:US
Practice Address - Phone:559-596-5107
Practice Address - Fax:559-596-5108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-27
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty