Healthcare Provider Details

I. General information

NPI: 1265477624
Provider Name (Legal Business Name): CARLOS L. CORDOBA M.D. INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 06/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

703 N FULTON ST
FRESNO CA
93728-3405
US

IV. Provider business mailing address

703 N FULTON ST
FRESNO CA
93728-3405
US

V. Phone/Fax

Practice location:
  • Phone: 559-233-3343
  • Fax: 559-233-3350
Mailing address:
  • Phone: 559-233-3343
  • Fax: 559-233-3350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. CARLOS L. CORDOBA
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 559-233-3343