Provider Demographics
NPI:1407114465
Name:VALLEY CENTER FOR PAIN MEDICINE AND REGIONAL ANESTHESIA CORP
Entity Type:Organization
Organization Name:VALLEY CENTER FOR PAIN MEDICINE AND REGIONAL ANESTHESIA CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HAI
Authorized Official - Middle Name:T
Authorized Official - Last Name:DUONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-761-6358
Mailing Address - Street 1:PO BOX 2123
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95344-0123
Mailing Address - Country:US
Mailing Address - Phone:209-381-0127
Mailing Address - Fax:209-381-0130
Practice Address - Street 1:3321 M ST
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95348
Practice Address - Country:US
Practice Address - Phone:209-381-0127
Practice Address - Fax:209-381-0130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-27
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA103786207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHG332AMedicare PIN