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General NPI Number Information
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NPI Number | 1154519007
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Entity Type | Organization
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Legal Business Name | CALIFORNIA VEIN & LASER CENTER MEDICAL CLINIC INC.
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Dates
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Enumeration Date | 10/04/2007
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Last Update Date | 05/14/2013
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Provider Practice Location Address
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Address Line | 7335 N 1ST ST STE 103
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City | FRESNO
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State | CA
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Zip | 93720-2968
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Country | US
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Telephone | 559-438-2800
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Fax | 559-438-8163
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Provider Business Mailing Address
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Address Line | 7335 N 1ST ST STE 103
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City | FRESNO
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State | CA
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Zip | 93720-2968
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Country | US
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Telephone | 559-438-2800
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Fax | 559-438-8163
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PAUL R MONTAGUE
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Credential | MD
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Telephone | 559-438-2800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | G27007
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License Number State | CA
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