Provider Demographics
NPI:1154704914
Name:CENTRAL VALLEY MOBILITY
Entity type:Organization
Organization Name:CENTRAL VALLEY MOBILITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ENRIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:TALAMANTES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-648-1994
Mailing Address - Street 1:105 BUSINESS PARK WAY
Mailing Address - Street 2:
Mailing Address - City:ATWATER
Mailing Address - State:CA
Mailing Address - Zip Code:95301-9483
Mailing Address - Country:US
Mailing Address - Phone:209-676-2791
Mailing Address - Fax:209-812-4315
Practice Address - Street 1:6084 JOSIE ST
Practice Address - Street 2:
Practice Address - City:ATWATER
Practice Address - State:CA
Practice Address - Zip Code:95301-9105
Practice Address - Country:US
Practice Address - Phone:209-648-1994
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-29
Last Update Date:2015-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA102-757630332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies