MEDICARE: JOGINDER S MATHARU M.D.

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	207V00000X	Obstetrics & Gynecology Physician	A28563	CA

General Provider Information

NPI Number	:	1750498408
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOGINDER S MATHARU M.D.

Provider Business Mailing Address
First Line	:	1383 E HERNDON AVE
Second Line	:	SUITE 102
City	:	FRESNO
State	:	CA
Zip	:	93720-3302
Country	:	US
Telephone Number	:	559-449-8004
Fax Number	:	559-449-8037

Provider Business Practice Location Address
First Line	:	1383 E HERNDON AVE
Second Line	:	SUITE 102
City	:	FRESNO
State	:	CA
Zip	:	93720-3302
Country	:	US
Telephone Number	:	559-449-8004
Fax Number	:	559-449-8037

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/25/2006
Last Update Date	:	07/08/2007

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