Healthcare Provider Details

I. General information

NPI: 1821164864
Provider Name (Legal Business Name): FRED LOGALBO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1867 E FIR AVE STE 101
FRESNO CA
93720-3841
US

IV. Provider business mailing address

1867 E FIR AVE STE 104
FRESNO CA
93720-3841
US

V. Phone/Fax

Practice location:
  • Phone: 559-325-5800
  • Fax:
Mailing address:
  • Phone: 559-325-5800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License NumberG65032
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberG65032
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: