Organization
SPECIALTY MEDICAL GROUP CENTRAL CALIFORNIA - DEPT OF UROLOGY
Active
Parent organization
SPECIALTY MEDICAL GROUP CENTRAL CALIFORNIA INC.
Organization subpart
Yes
Provider details
NPI number
Legal business name
SPECIALTY MEDICAL GROUP CENTRAL CALIFORNIA INC.
Authorized official
RALPH DIAZ M.D. (PRESIDENT AND MEDICAL DIRECTOR)
(559) 353-5700
Entity
Organization
Contact information
Practice address
9300 VALLEY CHILDRENS PL, MB16, MADERA, CA 93636-8761
(559) 353-6195
(559) 353-6196
Mailing address
9300 VALLEY CHILDRENS PL, MB16, MADERA, CA 93636-8761
(559) 353-6195
(559) 353-6196
Taxonomy
Speciality
Code
Description
License number
State
2088P0231X
Pediatric Urology Physician
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR007868L
—
CA
Enumeration date
12/13/2007
Last updated
12/13/2007
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