Healthcare Provider Details

I. General information

NPI: 1083644801
Provider Name (Legal Business Name): FRESNO CHILDREN'S MEDICAL GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7720 N FRESNO ST SUITE 104
FRESNO CA
93720-2407
US

IV. Provider business mailing address

7720 N FRESNO ST SUITE 104
FRESNO CA
93720-2407
US

V. Phone/Fax

Practice location:
  • Phone: 559-438-2300
  • Fax: 559-438-1531
Mailing address:
  • Phone: 559-438-2300
  • Fax: 559-438-1531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MAURICE GILLESPIE
Title or Position: C.E.O.
Credential: M.D.
Phone: 559-438-2300