Provider Demographics
NPI:1740513753
Name:ORANGE VALLEY PODIATRY GROUP
Entity type:Organization
Organization Name:ORANGE VALLEY PODIATRY GROUP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:K
Authorized Official - Last Name:GRANDT
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:559-734-1171
Mailing Address - Street 1:308 S JOHNSON ST
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-6136
Mailing Address - Country:US
Mailing Address - Phone:559-734-1171
Mailing Address - Fax:559-734-6849
Practice Address - Street 1:308 S JOHNSON ST
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-6136
Practice Address - Country:US
Practice Address - Phone:559-734-1171
Practice Address - Fax:559-734-6849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-09
Last Update Date:2009-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4724213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty