Provider Demographics
NPI:1346539483
Name:VALLEY MEDICAL GROUP OF KERN COUNTY INC
Entity Type:Organization
Organization Name:VALLEY MEDICAL GROUP OF KERN COUNTY INC
Other - Org Name:AVIATION MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/COO
Authorized Official - Prefix:MR
Authorized Official - First Name:NOEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:CABEZZAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-496-9300
Mailing Address - Street 1:PO BOX 640
Mailing Address - Street 2:
Mailing Address - City:SHAFTER
Mailing Address - State:CA
Mailing Address - Zip Code:93263-0640
Mailing Address - Country:US
Mailing Address - Phone:661-391-4530
Mailing Address - Fax:661-391-4536
Practice Address - Street 1:177 AVIATION ST
Practice Address - Street 2:
Practice Address - City:SHAFTER
Practice Address - State:CA
Practice Address - Zip Code:93263-4033
Practice Address - Country:US
Practice Address - Phone:661-391-4530
Practice Address - Fax:661-391-4536
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VALLEY MEDICAL GROUP OF KERN COUNTY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-03-29
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA63412Medicare UPIN