Healthcare Provider Details

I. General information

NPI: 1013361393
Provider Name (Legal Business Name): ABBY MEDICAL ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2016
Last Update Date: 05/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 N ABBY ST
FRESNO CA
93701-1906
US

IV. Provider business mailing address

PO BOX 25578
FRESNO CA
93729-5578
US

V. Phone/Fax

Practice location:
  • Phone: 559-455-1500
  • Fax: 559-253-1302
Mailing address:
  • Phone: 559-455-1500
  • Fax: 559-253-1302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA53378
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA53378
License Number StateCA

VIII. Authorized Official

Name: TEJINDER RANDHAWA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 559-455-1500