Provider Demographics
NPI:1518332493
Name:VALLEY CHILDREN'S PRIMARY CARE GROUP, INC.
Entity Type:Organization
Organization Name:VALLEY CHILDREN'S PRIMARY CARE GROUP, INC.
Other - Org Name:VALLEY CHILDREN'S PRIMARY CARE GROUP INC. - DAKOTA
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:CHRISTENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-353-3000
Mailing Address - Street 1:9300 VALLEY CHILDRENS PL
Mailing Address - Street 2:
Mailing Address - City:MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:93636-8761
Mailing Address - Country:US
Mailing Address - Phone:559-353-3000
Mailing Address - Fax:
Practice Address - Street 1:3636 N 1ST ST
Practice Address - Street 2:SUITE 120&121
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93726-6800
Practice Address - Country:US
Practice Address - Phone:559-224-4365
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VALLEY CHILDREN'S PRIMARY CARE GROUP, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-12-03
Last Update Date:2016-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty