Healthcare Provider Details

I. General information

NPI: 1366787475
Provider Name (Legal Business Name): INTERNAL MEDICINE CARDIOLOGY MEDICAL CLINIC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2012
Last Update Date: 11/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6335 N FRESNO ST SUITE 101
FRESNO CA
93710-5272
US

IV. Provider business mailing address

6335 N FRESNO ST SUITE 101
FRESNO CA
93710-5272
US

V. Phone/Fax

Practice location:
  • Phone: 559-436-1444
  • Fax: 559-436-4395
Mailing address:
  • Phone: 559-436-1444
  • Fax: 559-436-4395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. HYGIN T ANDREW
Title or Position: PRESIDENT
Credential: MD
Phone: 559-436-1444