Provider Demographics
NPI:1679397418
Name:ARYA MEDICAL GROUP CORP
Entity type:Organization
Organization Name:ARYA MEDICAL GROUP CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:KASEY
Authorized Official - Middle Name:
Authorized Official - Last Name:PAQUETTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-899-9172
Mailing Address - Street 1:121 BELMONT AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:MENDOTA
Mailing Address - State:CA
Mailing Address - Zip Code:93640-8231
Mailing Address - Country:US
Mailing Address - Phone:559-424-0610
Mailing Address - Fax:
Practice Address - Street 1:121 BELMONT AVE STE 100
Practice Address - Street 2:
Practice Address - City:MENDOTA
Practice Address - State:CA
Practice Address - Zip Code:93640-8231
Practice Address - Country:US
Practice Address - Phone:559-424-0610
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ARYA MEDICAL GROUP CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-11-08
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental