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General NPI Number Information
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NPI Number | 1346375136
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Entity Type | Organization
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Legal Business Name | SPRUCE MULTISPECIATLY GROUP
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Dates
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Enumeration Date | 02/22/2007
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Last Update Date | 09/21/2010
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Provider Practice Location Address
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Address Line | 1275 E SPRUCE AVE SUITE 101
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City | FRESNO
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State | CA
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Zip | 93720-3345
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Country | US
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Telephone | 559-226-0848
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Fax | 559-248-9585
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Provider Business Mailing Address
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Address Line | 1275 E SPRUCE AVE SUITE 101
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City | FRESNO
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State | CA
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Zip | 93720-3345
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Country | US
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Telephone | 559-226-0848
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Fax | 559-248-9585
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Authorized Official
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Title or Position | OFFICE SUPERVISOR
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Name | MRS. BARBARA CORDOVA
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Credential |
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Telephone | 559-226-0848
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A43475
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A29316
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A79525
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | G36222
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License Number State | CA
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Taxonomy #5
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | G32784
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License Number State | CA
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Taxonomy #6
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | G48359
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License Number State | CA
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