Healthcare Provider Details

I. General information

NPI: 1720759871
Provider Name (Legal Business Name): CARPIO-BRACHO & GUTIERREZ, A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2021
Last Update Date: 07/06/2022
Certification Date: 07/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3636 N 1ST ST STE 160
FRESNO CA
93726-6869
US

IV. Provider business mailing address

3636 N 1ST ST STE 160
FRESNO CA
93726-6869
US

V. Phone/Fax

Practice location:
  • Phone: 559-944-9298
  • Fax:
Mailing address:
  • Phone: 559-944-9298
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: GABRIEL CARPIO-BRACHO
Title or Position: PRESIDENT
Credential: MD
Phone: 559-944-9298