Provider Demographics
NPI:1407843345
Name:VALLEY OAK PEDIATRIC ASSOCIATES
Entity Type:Organization
Organization Name:VALLEY OAK PEDIATRIC ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:L
Authorized Official - Last Name:KOCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-544-7300
Mailing Address - Street 1:4120 PRESCOTT RD
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95356-8418
Mailing Address - Country:US
Mailing Address - Phone:209-544-7300
Mailing Address - Fax:209-544-7323
Practice Address - Street 1:4120 PRESCOTT RD
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95356-8418
Practice Address - Country:US
Practice Address - Phone:209-544-7300
Practice Address - Fax:209-544-7323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0100530OtherGROUP MEDI-CAL NUMBER