Healthcare Provider Details

I. General information

NPI: 1225081789
Provider Name (Legal Business Name): GHASSAN SIMON BACHIR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 06/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 E. ALMOND AVE SUITE 103
MADERA CA
93637-5691
US

IV. Provider business mailing address

9526 NORTH WINERY AVENUE
FRESNO CA
93720-4600
US

V. Phone/Fax

Practice location:
  • Phone: 559-661-7000
  • Fax:
Mailing address:
  • Phone: 559-250-9588
  • Fax: 559-322-5182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA42006
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberA42006
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberA42006
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: