Provider Demographics
NPI:1497953863
Name:CENTRAL VALLEY OBSTETRICS & GYNECOLOGY MED GRP, INC
Entity Type:Organization
Organization Name:CENTRAL VALLEY OBSTETRICS & GYNECOLOGY MED GRP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEPUTY DIRECTOR MEDICAL STAFF SVCS
Authorized Official - Prefix:
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:L
Authorized Official - Last Name:HATCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-468-6000
Mailing Address - Street 1:500 WEST HOSPITAL ROAD
Mailing Address - Street 2:
Mailing Address - City:FRENCH CAMP
Mailing Address - State:CA
Mailing Address - Zip Code:95231-0000
Mailing Address - Country:US
Mailing Address - Phone:209-468-6000
Mailing Address - Fax:
Practice Address - Street 1:500 WEST HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:FRENCH CAMP
Practice Address - State:CA
Practice Address - Zip Code:95231-0000
Practice Address - Country:US
Practice Address - Phone:209-473-6555
Practice Address - Fax:209-473-6544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-06
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0051820Medicaid
CAZZZ30852ZMedicare ID - Type Unspecified