Provider Demographics
NPI:1194981894
Name:VALLEY REHAB MEDICAL GROUP
Entity type:Organization
Organization Name:VALLEY REHAB MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GROUP ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:DZAKOWIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-325-3070
Mailing Address - Street 1:1805 E FIR AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3859
Mailing Address - Country:US
Mailing Address - Phone:559-325-3070
Mailing Address - Fax:559-325-3073
Practice Address - Street 1:1805 E FIR AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3859
Practice Address - Country:US
Practice Address - Phone:559-325-3070
Practice Address - Fax:559-325-3073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-01
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Multi-Specialty