Provider Demographics
NPI:1689983967
Name:CENTRAL VALLEY MULTISPECIALTY MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:CENTRAL VALLEY MULTISPECIALTY MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/C.E.O.
Authorized Official - Prefix:
Authorized Official - First Name:BRENTON
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-867-4416
Mailing Address - Street 1:PO BOX 217
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93656-0217
Mailing Address - Country:US
Mailing Address - Phone:559-867-4416
Mailing Address - Fax:
Practice Address - Street 1:20647 MALSBARY ST
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:CA
Practice Address - Zip Code:93656-9208
Practice Address - Country:US
Practice Address - Phone:559-867-4416
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-04
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty