MEDICARE: MARIANO & QUEROL MEDICAL ASSOCIATES, 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	208D00000X	General Practice Physician	A88903	CA

General Provider Information

NPI Number	:	1861520264
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARIANO & QUEROL MEDICAL ASSOCIATES, INC.

Provider Business Mailing Address
First Line	:	3636 N 1ST ST
Second Line	:	SUITE 150
City	:	FRESNO
State	:	CA
Zip	:	93726-6800
Country	:	US
Telephone Number	:	559-222-5900
Fax Number	:	559-222-0029

Provider Business Practice Location Address
First Line	:	3636 N 1ST ST
Second Line	:	SUITE 150
City	:	FRESNO
State	:	CA
Zip	:	93726-6800
Country	:	US
Telephone Number	:	559-222-5900
Fax Number	:	559-222-0029

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. HIPOLITO GALLARDO MARIANO JR.
Credential	:	M.D
Telephone Number	:	559-222-5900

Provider Enumeration Date	:	02/28/2007
Last Update Date	:	08/20/2007

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