MEDICARE: VISALIA FAMILY PRACTICE MEDICAL GROUP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1073681730
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VISALIA FAMILY PRACTICE MEDICAL GROUP

Provider Business Mailing Address
First Line	:	107 N HALL ST STE D
Second Line	:
City	:	VISALIA
State	:	CA
Zip	:	93291-5850
Country	:	US
Telephone Number	:	559-625-9200
Fax Number	:	559-625-0665

Provider Business Practice Location Address
First Line	:	107 N HALL ST STE D
Second Line	:
City	:	VISALIA
State	:	CA
Zip	:	93291-5850
Country	:	US
Telephone Number	:	559-625-9200
Fax Number	:	559-625-0665

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. BREANA BERGDORF
Credential	:
Telephone Number	:	559-625-9200

Provider Enumeration Date	:	12/01/2006
Last Update Date	:	01/05/2023

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