Healthcare Provider Details

I. General information

NPI: 1316563992
Provider Name (Legal Business Name): FOUR CORNER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2020
Last Update Date: 06/19/2020
Certification Date: 06/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 E OLIVE AVE
FRESNO CA
93728-3610
US

IV. Provider business mailing address

PO BOX 690311
STOCKTON CA
95269-0311
US

V. Phone/Fax

Practice location:
  • Phone: 800-666-5323
  • Fax:
Mailing address:
  • Phone: 800-666-5323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. CASHMIR LUKE
Title or Position: PRESIDENT
Credential: PHARMD/PH.D
Phone: 800-666-5323