Provider Demographics
NPI:1467992412
Name:CENTRAL VALLEY FUNCTIONAL RESTORATION PROGRAM
Entity Type:Organization
Organization Name:CENTRAL VALLEY FUNCTIONAL RESTORATION PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:CATON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-491-5370
Mailing Address - Street 1:2004 MCHENRY AVE
Mailing Address - Street 2:STE C
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-3260
Mailing Address - Country:US
Mailing Address - Phone:209-337-3377
Mailing Address - Fax:209-729-5353
Practice Address - Street 1:2004 MCHENRY AVE
Practice Address - Street 2:STE C
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-3260
Practice Address - Country:US
Practice Address - Phone:209-337-3377
Practice Address - Fax:209-729-5353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-24
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty