Healthcare Provider Details

I. General information

NPI: 1770809055
Provider Name (Legal Business Name): HANFORD PRIMARY CARE MEDICAL ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2010
Last Update Date: 10/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5109 W GOSHEN AVE
VISALIA CA
93291-8620
US

IV. Provider business mailing address

5109 W GOSHEN AVE
VISALIA CA
93291-8620
US

V. Phone/Fax

Practice location:
  • Phone: 559-740-7989
  • Fax: 559-740-7952
Mailing address:
  • Phone: 559-740-7989
  • Fax: 559-740-7952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA85143
License Number StateCA

VIII. Authorized Official

Name: DARIA MAJZOUBI
Title or Position: CEO
Credential: MD
Phone: 559-740-7989