Healthcare Provider Details

I. General information

NPI: 1396029153
Provider Name (Legal Business Name): MONARCH OBSTETRICS MANAGEMENT SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2011
Last Update Date: 10/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 WILLOW PLZ STE 201
VISALIA CA
93291-6213
US

IV. Provider business mailing address

100 WILLOW PLZ STE 201
VISALIA CA
93291-6213
US

V. Phone/Fax

Practice location:
  • Phone: 559-627-9284
  • Fax: 559-713-0965
Mailing address:
  • Phone: 559-627-9284
  • Fax: 559-713-0965

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberG79867
License Number StateCA

VIII. Authorized Official

Name: MARK D WISEMAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 559-627-9284