MEDICARE: FRESNO DERMATOLOGY SPECIALISTS, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	A121126	CA

General Provider Information

NPI Number	:	1891035127
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FRESNO DERMATOLOGY SPECIALISTS, INC

Provider Business Mailing Address
First Line	:	7025 N CHESTNUT AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93720-0351
Country	:	US
Telephone Number	:	559-233-3376
Fax Number	:	559-233-6647

Provider Business Practice Location Address
First Line	:	7025 N CHESTNUT AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93720-0351
Country	:	US
Telephone Number	:	559-233-3376
Fax Number	:	559-233-6647

Authorized Official
Title or Position	:	OWNER
Name	:	CARLOS PAZ
Credential	:	MD
Telephone Number	:	559-233-3376

Provider Enumeration Date	:	02/23/2013
Last Update Date	:	07/02/2013

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