Provider Demographics
NPI:1578648903
Name:VALLEY PSYCHIATRIC PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:VALLEY PSYCHIATRIC PROFESSIONAL CORPORATION
Other - Org Name:VALLEY PSYCHIATRIC ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-OWNER/CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:CHEANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-524-1900
Mailing Address - Street 1:1011 COFFEE RD
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-4203
Mailing Address - Country:US
Mailing Address - Phone:209-524-1900
Mailing Address - Fax:209-524-1991
Practice Address - Street 1:1011 COFFEE RD
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-4203
Practice Address - Country:US
Practice Address - Phone:209-524-1900
Practice Address - Fax:209-524-1991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2737085261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health