Provider Demographics
NPI:1356425110
Name:VALLEY SURGICAL SPECIALISTS MEDICAL GRP INC
Entity type:Organization
Organization Name:VALLEY SURGICAL SPECIALISTS MEDICAL GRP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:MICHIO
Authorized Official - Last Name:MARUYAMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-450-3901
Mailing Address - Street 1:1125 EAST SPRUCE AVENUE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3330
Mailing Address - Country:US
Mailing Address - Phone:559-450-3901
Mailing Address - Fax:559-450-3903
Practice Address - Street 1:1125 EAST SPRUCE AVENUE
Practice Address - Street 2:SUITE 101
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3330
Practice Address - Country:US
Practice Address - Phone:559-450-3901
Practice Address - Fax:559-450-3903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2008-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ83094ZMedicare ID - Type Unspecified