Organization
INDEPENDENCE MEDICAL GROUP OF CENTRAL CALIFORNIA, INC.
Active
Other names
Independence Medical Group
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES HABERKERN (VICE PRESIDENT)
(661) 496-5638
Entity
Organization
Contact information
Practice address
100 WILLOW PLZ, SUITE 405, VISALIA, CA 93291-6206
(559) 802-1105
(559) 750-4081
Mailing address
100 WILLOW PLZ, SUITE 405, VISALIA, CA 93291-6206
(559) 802-1105
(559) 750-4081
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
—
—
Other
Enumeration date
04/07/2009
Last updated
04/07/2009
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