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General NPI Number Information
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NPI Number | 1780631127
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Entity Type | Organization
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Legal Business Name | GASTROENTEROLOGY AND LIVER DISEASE MEDICAL CENTER INC
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Dates
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Enumeration Date | 05/30/2006
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Last Update Date | 03/21/2024
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Provider Practice Location Address
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Address Line | 7215 N FRESNO ST #101
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City | FRESNO
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State | CA
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Zip | 93720-2969
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Country | US
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Telephone | 559-449-0309
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Fax | 559-449-0609
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Provider Business Mailing Address
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Address Line | 7215 N FRESNO ST #101
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City | FRESNO
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State | CA
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Zip | 93720-2969
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Country | US
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Telephone | 559-449-0309
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Fax | 559-449-0609
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. AUDRA E ORBAKER
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Credential |
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Telephone | 559-760-9981
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | AS1593001
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License Number State | CA
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