Healthcare Provider Details

I. General information

NPI: 1649509647
Provider Name (Legal Business Name): PEDIATRIC GASTROENTEROLOGY CONSULTANTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2009
Last Update Date: 12/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 VALLEY CHILDRENS PL
MADERA CA
93636-8761
US

IV. Provider business mailing address

1895 E CASTLEBROOK DR
FRESNO CA
93730-3456
US

V. Phone/Fax

Practice location:
  • Phone: 559-353-5745
  • Fax: 559-353-6033
Mailing address:
  • Phone: 559-353-5745
  • Fax: 559-353-6033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License NumberC050493
License Number StateCA

VIII. Authorized Official

Name: DR. MOHAMMAD MUSLIM JAMI
Title or Position: MANAGER
Credential: MD
Phone: 559-353-5745