Basic Information
| Provider Information | |||||||||
| NPI: | 1740682319 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CENTRAL VALLEY PALLIATIVE MEDICINE INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7145 N CHESTNUT AVE | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937200359 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5592847264 | ||||||||
| FaxNumber: | 5593262170 | ||||||||
| Practice Location | |||||||||
| Address1: | 7145 N CHESTNUT AVE | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937200359 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5592847264 | ||||||||
| FaxNumber: | 5593262170 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/25/2014 | ||||||||
| LastUpdateDate: | 09/25/2014 | ||||||||
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| AuthorizedOfficialLastName: | COPELAND | ||||||||
| AuthorizedOfficialFirstName: | GREGORY | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5592847264 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DO | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QH0002X | 20A10829 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | Hospice and Palliative Medicine |
No ID Information.