Healthcare Provider Details

I. General information

NPI: 1871699561
Provider Name (Legal Business Name): LINET R D'MORIAS M D INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 02/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1303 E. HERNDON AVE MAIL STOP 35
FRESNO CA
93720-9860
US

IV. Provider business mailing address

6327 N FRESNO ST SUITE #104
FRESNO CA
93710-5236
US

V. Phone/Fax

Practice location:
  • Phone: 559-431-4020
  • Fax: 559-431-4589
Mailing address:
  • Phone: 559-431-4020
  • Fax: 559-431-4589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA48021
License Number StateCA

VIII. Authorized Official

Name: DR. LINET R D'MORIAS
Title or Position: PHYSICIAN/PRESIDENT
Credential: M.D
Phone: 559-431-4020