Provider Demographics
NPI:1861847170
Name:ADVANCED CENTRAL VALLEY VASCULAR INSTITUTE, INC
Entity Type:Organization
Organization Name:ADVANCED CENTRAL VALLEY VASCULAR INSTITUTE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MUHAMMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAUDHRI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-627-0112
Mailing Address - Street 1:3550 Q ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-1662
Mailing Address - Country:US
Mailing Address - Phone:661-321-9767
Mailing Address - Fax:661-321-9747
Practice Address - Street 1:3550 Q ST
Practice Address - Street 2:SUITE 205
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-1662
Practice Address - Country:US
Practice Address - Phone:661-321-9767
Practice Address - Fax:661-321-9747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-25
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QM2500X, 261QR0200X, 261QR0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No261QR0207XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile Mammography