CENTRAL CALIF ENT MEDICAL GROUP
Allergy and Immunology
Fresno, California
Provider NPI: 1083673842
Organization Information:Organization Name: CENTRAL CALIF ENT MEDICAL GROUP
Practice Location:
1351 E SPRUCE AVE FRESNO, CA 93720 US
Tel: 559-432-3303 Fax: --
Business Mailing Address:
,
Tel: -- Fax: --
Taxonomy:
Other Provider Identifiers:
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin
Practice Location:
1351 E SPRUCE AVE FRESNO, CA 93720 US
Tel: 559-432-3303 Fax: --
Business Mailing Address:
,
Tel: -- Fax: --
Taxonomy:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| X | 207K00000X | Physicians Allergy & Immunology | ||
| X | 207Y00000X | Physicians Otolaryngology | ||
| X | 208200000X | Physicians Plastic Surgery |
Other Provider Identifiers:
| Issuer | Number | State | Type |
|---|---|---|---|
| BLUE SHIELD | ZZZ49290Z | CA | 01 |
| GR0070230 | CA | 05 | |
| BLUE CROSS | ZZZ49290Z | CA | 01 |
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin
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