Provider Demographics
NPI:1548487580
Name:SUCCESS VALLEY MEDICAL GROUP, INC
Entity type:Organization
Organization Name:SUCCESS VALLEY MEDICAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HUGO
Authorized Official - Middle Name:RENE
Authorized Official - Last Name:ESCOBAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-781-6323
Mailing Address - Street 1:53 E CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93257-3748
Mailing Address - Country:US
Mailing Address - Phone:559-781-6323
Mailing Address - Fax:559-781-7290
Practice Address - Street 1:53 E CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-3748
Practice Address - Country:US
Practice Address - Phone:559-781-6323
Practice Address - Fax:559-781-7290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA218212086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ76348ZMedicaid
CAZZZ76348ZMedicaid
CAZZZ76348ZMedicare ID - Type UnspecifiedGROUP ID NUMBER