MEDICARE: CALIFORNIA INDUSTRIAL MEDICINE, INC.

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	174400000X	Specialist	C12065	CA

General Provider Information

NPI Number	:	1689856171
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CALIFORNIA INDUSTRIAL MEDICINE, INC.

Provider Business Mailing Address
First Line	:	2841 TULARE ST
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93721-1320
Country	:	US
Telephone Number	:	559-435-3696
Fax Number	:	559-435-3698

Provider Business Practice Location Address
First Line	:	2841 TULARE ST
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93721-1320
Country	:	US
Telephone Number	:	559-435-3696
Fax Number	:	559-435-3698

Authorized Official
Title or Position	:	DIRECTOR OF BUSINESS OPERATIONS
Name	:	MR. SHELBY V JOBE
Credential	:
Telephone Number	:	831-212-2123

Provider Enumeration Date	:	11/27/2007
Last Update Date	:	03/01/2011

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