Provider Demographics
NPI:1013063015
Name:VALLEY MEDICAL GROUP OF KERN COUNTY, INC
Entity Type:Organization
Organization Name:VALLEY MEDICAL GROUP OF KERN COUNTY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CLAUDIA
Authorized Official - Middle Name:
Authorized Official - Last Name:FUENTES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-836-4000
Mailing Address - Street 1:PO BOX 11510
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93389-1510
Mailing Address - Country:US
Mailing Address - Phone:661-836-4000
Mailing Address - Fax:661-847-4097
Practice Address - Street 1:5401 WHITE LN
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-6279
Practice Address - Country:US
Practice Address - Phone:661-836-4000
Practice Address - Fax:661-847-4097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA429860261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5402560001OtherNORIDIAN MEDICARE
CAGR0084020Medicaid
CADA7903OtherMEDICARE RAILROAD
CA5402560001OtherNORIDIAN MEDICARE