Healthcare Provider Details

I. General information

NPI: 1861733974
Provider Name (Legal Business Name): UNITED CALIFORNIA SURGICAL FORUM INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2013
Last Update Date: 03/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E ALMOND AVE
MADERA CA
93637-5693
US

IV. Provider business mailing address

1000 E ALMOND AVE # 3A
MADERA CA
93637-5693
US

V. Phone/Fax

Practice location:
  • Phone: 559-673-5657
  • Fax: 559-549-9736
Mailing address:
  • Phone: 559-673-5657
  • Fax: 559-549-9736

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number112001
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number112001
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number112001
License Number StateCA

VIII. Authorized Official

Name: DR. RAME D IBERDEMAJ
Title or Position: PRESIDENT
Credential: M.D.,
Phone: 559-673-5657