Provider Demographics
NPI:1366829640
Name:CENTRAL VALLEY CRITICAL CARE MEDICINE - A PROFESSIONAL CORPORAT
Entity Type:Organization
Organization Name:CENTRAL VALLEY CRITICAL CARE MEDICINE - A PROFESSIONAL CORPORAT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:VISHNU
Authorized Official - Middle Name:V
Authorized Official - Last Name:BEZWADA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-272-5589
Mailing Address - Street 1:5211 W GOSHEN AVE
Mailing Address - Street 2:PMB 326
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-8619
Mailing Address - Country:US
Mailing Address - Phone:559-802-5596
Mailing Address - Fax:559-802-5816
Practice Address - Street 1:400 W MINERAL KING AVE
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291
Practice Address - Country:US
Practice Address - Phone:559-624-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-06
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC50351207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Single Specialty