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General NPI Number Information
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NPI Number | 1255341814
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Entity Type | Organization
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Legal Business Name | CARDIAC INSTITUTE OF CENTRAL CALIFORNIA A MEDICAL CORPORATION
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Dates
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Enumeration Date | 08/08/2006
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Last Update Date | 03/14/2013
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Provider Practice Location Address
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Address Line | 30 RIVER PARK PLACE W 440
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City | FRESNO
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State | CA
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Zip | 93720
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Country | US
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Telephone | 559-256-5500
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Fax | 559-256-5505
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Provider Business Mailing Address
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Address Line | 30 RIVER PARK PLACE W 440
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City | FRESNO
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State | CA
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Zip | 93720
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Country | US
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Telephone | 559-256-5500
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Fax | 559-256-5505
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | SAM A BORNO
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Credential | MD
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Telephone | 559-256-5500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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