Healthcare Provider Details

I. General information

NPI: 1821075748
Provider Name (Legal Business Name): COMMUNITY MEDICAL PROVIDERS MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2005
Last Update Date: 10/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1180 E SHAW AVE STE 125
FRESNO CA
93710-7812
US

IV. Provider business mailing address

PO BOX 28900
FRESNO CA
93729
US

V. Phone/Fax

Practice location:
  • Phone: 559-228-4200
  • Fax: 559-224-3920
Mailing address:
  • Phone: 559-228-4200
  • Fax: 559-224-3920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG50552
License Number StateCA

VIII. Authorized Official

Name: GRANT NAKAMURA
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 559-228-5400