| Centurion Valley Healthcare Inc. | |
|
6337 Brook Hollow Cir Stockton CA 95219-2441 | |
| (209) 910-0701 | |
| (209) 910-9763 |
| Full Name | Centurion Valley Healthcare Inc. |
|---|---|
| Speciality | Internal Medicine |
| Location | 6337 Brook Hollow Cir, Stockton, California |
| Authorized Official Name and Position | Htay Minn (PRESIDENT) |
| Authorized Official Contact | 2099100701 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Centurion Valley Healthcare Inc. 6337 Brook Hollow Cir Stockton CA 95219-2441 Ph: (209) 910-0701 | Centurion Valley Healthcare Inc. 6337 Brook Hollow Cir Stockton CA 95219-2441 Ph: (209) 910-0701 |
| NPI Number | 1750773792 |
|---|---|
| Provider Enumeration Date | 02/27/2015 |
| Last Update Date | 02/27/2015 |
| Medicare PECOS PAC ID | 4082932470 |
|---|---|
| Medicare Enrollment ID | O20150415001003 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750773792 | NPI | - | NPPES |
| 1992765523 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Htay Minn |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1992765523 PECOS PAC ID: 9335129352 Enrollment ID: I20070629000237 |
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