Healthcare Provider Details

I. General information

NPI: 1083639850
Provider Name (Legal Business Name): COMMUNITY PERINATOLOGY MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 05/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 N VALERIA ST SUITE 204
FRESNO CA
93701-2166
US

IV. Provider business mailing address

PO BOX 28913
FRESNO CA
93729-8913
US

V. Phone/Fax

Practice location:
  • Phone: 559-233-7700
  • Fax: 559-233-7744
Mailing address:
  • Phone: 559-228-4298
  • Fax: 559-224-3920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA48104
License Number StateCA

VIII. Authorized Official

Name: PATRICK STUART
Title or Position: PRESIDENT
Credential: D.O.
Phone: 559-228-4298