Organization
CENTRAL VALLEY ENT MEDICAL GROUP INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS EDWARD KILLEEN M.D. (PRESIDENT)
(209) 524-6681
Entity
Organization
Contact information
Practice address
1600 SUNRISE AVE, SUITE 16, MODESTO, CA 95350-4679
(209) 524-6681
(209) 524-2962
Mailing address
1600 SUNRISE AVE, SUITE 16, MODESTO, CA 95350-4679
(209) 524-6681
(209) 524-2962
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ZZZ73209Z
—
CA
Enumeration date
08/30/2006
Last updated
08/22/2020
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