MEDICARE: MUSCULAR SKELETAL MEDICAL ASSOCIATES, 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	207ZI0100X	Immunopathology Physician	020A53070	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902905755
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MUSCULAR SKELETAL MEDICAL ASSOCIATES, INC

Provider Business Mailing Address
First Line	:	3726 N 1ST ST
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93726-5601
Country	:	US
Telephone Number	:	559-248-0116
Fax Number	:	559-248-0119

Provider Business Practice Location Address
First Line	:	3726 N 1ST ST
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93726-5601
Country	:	US
Telephone Number	:	559-248-0116
Fax Number	:	559-248-0119

Authorized Official
Title or Position	:	OWNER
Name	:	DANIEL B. BRUBAKER
Credential	:	D.O.
Telephone Number	:	559-248-0116

Provider Enumeration Date	:	09/21/2006
Last Update Date	:	05/01/2020

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