Healthcare Provider Details

I. General information

NPI: 1497724355
Provider Name (Legal Business Name): CARDIOVASCULAR CONSULTANTS OF FRESNO, A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1207 E HERNDON AVE
FRESNO CA
93720-3235
US

IV. Provider business mailing address

1207 E HERNDON AVE
FRESNO CA
93720-3235
US

V. Phone/Fax

Practice location:
  • Phone: 553-432-4303
  • Fax: 559-432-4574
Mailing address:
  • Phone: 553-432-4303
  • Fax: 559-432-4574

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MARIA RODRIGUEZ
Title or Position: REVENUE CYCLE MANAER
Credential:
Phone: 559-432-8146