Provider Demographics
NPI:1457500456
Name:CENTRAL VALLEY MEDICAL SUPPLY
Entity Type:Organization
Organization Name:CENTRAL VALLEY MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:SAUL
Authorized Official - Last Name:CALDERA
Authorized Official - Suffix:
Authorized Official - Credentials:REHAB TECHNOLOGY SUP
Authorized Official - Phone:209-826-4810
Mailing Address - Street 1:245 W PACHECO BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:LOS BANOS
Mailing Address - State:CA
Mailing Address - Zip Code:93635-4067
Mailing Address - Country:US
Mailing Address - Phone:209-826-4810
Mailing Address - Fax:209-826-7376
Practice Address - Street 1:245 W PACHECO BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:LOS BANOS
Practice Address - State:CA
Practice Address - Zip Code:93635-4067
Practice Address - Country:US
Practice Address - Phone:209-826-4810
Practice Address - Fax:209-826-7376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-15
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies