MEDICARE: CANTERBURY WOMENS HEALTH CARE MEDICAL GROUP 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	207V00000X	Obstetrics & Gynecology Physician

General Provider Information

NPI Number	:	1891889994
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CANTERBURY WOMENS HEALTH CARE MEDICAL GROUP INC

Provider Business Mailing Address
First Line	:	6167 N FRESNO ST STE 102
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93710-8610
Country	:	US
Telephone Number	:	559-322-2255
Fax Number	:	559-322-4636

Provider Business Practice Location Address
First Line	:	6167 N FRESNO ST STE 102
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93710-8610
Country	:	US
Telephone Number	:	559-322-2255
Fax Number	:	559-322-4636

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MARSHALL NOEL
Credential	:	MD
Telephone Number	:	559-322-2255

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	06/11/2019

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