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General NPI Number Information
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NPI Number | 1821075748
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Entity Type | Organization
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Legal Business Name | COMMUNITY MEDICAL PROVIDERS MEDICAL GROUP INC
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Dates
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Enumeration Date | 12/30/2005
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Last Update Date | 10/25/2011
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Provider Practice Location Address
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Address Line | 1180 E SHAW AVE STE 125
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City | FRESNO
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State | CA
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Zip | 93710-7812
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Country | US
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Telephone | 559-228-4200
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Fax | 559-224-3920
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Provider Business Mailing Address
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Address Line | PO BOX 28900
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City | FRESNO
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State | CA
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Zip | 93729
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Country | US
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Telephone | 559-228-4200
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Fax | 559-224-3920
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | GRANT NAKAMURA
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Credential | MD
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Telephone | 559-228-5400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | G50552
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License Number State | CA
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