Provider Demographics
NPI:1598072662
Name:GREEN VALLEY MEDICAL CORPORATION
Entity Type:Organization
Organization Name:GREEN VALLEY MEDICAL CORPORATION
Other - Org Name:GREEN VALLEY MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AURORA GRACE E
Authorized Official - Middle Name:
Authorized Official - Last Name:HWANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-528-1777
Mailing Address - Street 1:835 SEQUOIA AVE
Mailing Address - Street 2:
Mailing Address - City:LINDSAY
Mailing Address - State:CA
Mailing Address - Zip Code:93247-1424
Mailing Address - Country:US
Mailing Address - Phone:559-528-1777
Mailing Address - Fax:
Practice Address - Street 1:41689 ROAD 128
Practice Address - Street 2:
Practice Address - City:OROSI
Practice Address - State:CA
Practice Address - Zip Code:93647-2060
Practice Address - Country:US
Practice Address - Phone:559-528-1777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-09
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health