Healthcare Provider Details

I. General information

NPI: 1629172994
Provider Name (Legal Business Name): MADERA FAMILY MEDICAL GROUP INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2006
Last Update Date: 03/23/2022
Certification Date: 03/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 W 4TH ST
MADERA CA
93637-4474
US

IV. Provider business mailing address

1111 W 4TH ST
MADERA CA
93637-4474
US

V. Phone/Fax

Practice location:
  • Phone: 559-673-3000
  • Fax: 559-662-2910
Mailing address:
  • Phone: 559-673-3000
  • Fax: 559-662-2910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: AFTAB A NAZ
Title or Position: PRESIDENT
Credential:
Phone: 559-673-3000