Healthcare Provider Details

I. General information

NPI: 1760415103
Provider Name (Legal Business Name): MADERA PULMONARY AND SLEEP DISORDERS CENTER A MEDICAL CORPORA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 12/24/2019
Certification Date: 12/24/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1280 E ALMOND AVE
MADERA CA
93637-5606
US

IV. Provider business mailing address

1280 E ALMOND AVE
MADERA CA
93637-5606
US

V. Phone/Fax

Practice location:
  • Phone: 559-673-9021
  • Fax: 559-673-6234
Mailing address:
  • Phone: 559-673-9021
  • Fax: 559-673-6234

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA38439
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA63120
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberA63120
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberA38439
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberA63120
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License NumberA63120
License Number StateCA
# 7
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License NumberA38439
License Number StateCA

VIII. Authorized Official

Name: MAZHAR JAVAID
Title or Position: CEO
Credential: M D
Phone: 559-673-9021