Provider Demographics
NPI:1710030176
Name:CENTRAL VALLEY MEDICAL SUPPLIES & EQUIPMENT, INC.
Entity Type:Organization
Organization Name:CENTRAL VALLEY MEDICAL SUPPLIES & EQUIPMENT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:VERGIE MARY
Authorized Official - Middle Name:AGANAN
Authorized Official - Last Name:CELESTINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-724-9449
Mailing Address - Street 1:3597 SANTIAGO AVE
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95348-9500
Mailing Address - Country:US
Mailing Address - Phone:209-724-9449
Mailing Address - Fax:209-724-9449
Practice Address - Street 1:3597 SANTIAGO AVE
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95348-9500
Practice Address - Country:US
Practice Address - Phone:209-724-9449
Practice Address - Fax:209-724-9449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA2962454OtherSECRETARY O F STATE ID