Provider Demographics
NPI:1952159162
Name:CENCAL MEDICAL GROUP
Entity Type:Organization
Organization Name:CENCAL MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SWARNA
Authorized Official - Middle Name:
Authorized Official - Last Name:BYRI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-321-1573
Mailing Address - Street 1:PO BOX 144
Mailing Address - Street 2:
Mailing Address - City:MANTECA
Mailing Address - State:CA
Mailing Address - Zip Code:95336-1122
Mailing Address - Country:US
Mailing Address - Phone:602-321-1573
Mailing Address - Fax:
Practice Address - Street 1:3141 PELLARO CT
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94566-2104
Practice Address - Country:US
Practice Address - Phone:602-321-1573
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-11
Last Update Date:2024-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty