Healthcare Provider Details

I. General information

NPI: 1760916951
Provider Name (Legal Business Name): PINERIDGE OBSTETRIX & GYNECOLOGY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2017
Last Update Date: 05/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2137 HERNDON AVE SUITE 102
CLOVIS CA
93611-6306
US

IV. Provider business mailing address

2137 HERNDON AVE SUITE 102
CLOVIS CA
93611-6306
US

V. Phone/Fax

Practice location:
  • Phone: 559-466-7100
  • Fax: 559-466-7102
Mailing address:
  • Phone: 559-466-7100
  • Fax: 559-466-7102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number StateCA

VIII. Authorized Official

Name: ISRAEL K. BROWN
Title or Position: OWNER
Credential: MD
Phone: 559-466-7100