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NPI Code Detail

MEDICARE: CENTRAL CALIFORNIA FACULTY MEDICAL GROUP, INC.

MEDICARE: CENTRAL CALIFORNIA FACULTY MEDICAL GROUP, 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
1207V00000XObstetrics & Gynecology Physician
2208000000XPediatrics Physician
32084N0400XNeurology Physician
4207Q00000XFamily Medicine Physician
5207QA0000XAdolescent Medicine (Family Medicine) Physician
6207QA0505XAdult Medicine Physician
7207RC0000XCardiovascular Disease Physician
8207RC0200XCritical Care Medicine (Internal Medicine) Physician
9207RE0101XEndocrinology, Diabetes & Metabolism Physician
10207RG0100XGastroenterology Physician
11207RH0003XHematology & Oncology Physician
12207RI0011XInterventional Cardiology Physician
13207RI0200XInfectious Disease Physician
14207R00000XInternal Medicine Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1992742852
Entity Type Code : Organization
Provider Name (Legal Business Name) : CENTRAL CALIFORNIA FACULTY MEDICAL GROUP, INC.
Provider Business Mailing Address
First Line : 2625 E DIVISADERO ST
Second Line :
City : FRESNO
State : CA
Zip : 93721-1431
Country : US
Telephone Number : 559-453-5200
Fax Number : 559-443-2681
Provider Business Practice Location Address
First Line : 604 N MAGNOLIA AVE STE 100
Second Line :
City : CLOVIS
State : CA
Zip : 93611-9205
Country : US
Telephone Number : 559-320-0531
Fax Number : 559-320-0539
Authorized Official
Title or Position : PRESIDENT
Name : RANDALL STERN
Credential : MD
Telephone Number : 559-443-2682
Provider Enumeration Date : 06/01/2006
Last Update Date : 06/13/2025

Similar Medicare Providers

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Practice Location Address:
604 N MAGNOLIA AVE STE 100
CLOVIS, CA
93611-9205
Practice Phone: 559-320-0531
Practice Fax: 559-320-0539
1952301087 — SIMON FARID MIZYED PA-C
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Practice Fax: 559-320-0539
1205815164 — NATHAN A HOEKZEMA M.D.
Practice Location Address:
604 N MAGNOLIA AVE STE 100
CLOVIS, CA
93611-9205
Practice Phone: 559-320-0531
Practice Fax: 559-320-0539
1992772610 — DENIZ BAYSAL MD, FRCP
Practice Location Address:
604 N MAGNOLIA AVE STE 100
CLOVIS, CA
93611-9205
Practice Phone: 559-320-0531
Practice Fax: 559-320-0539
1114087046 — ARMEN MARTIROSIAN MD
Practice Location Address:
604 N MAGNOLIA AVE STE 100
CLOVIS, CA
93611-9205
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Practice Fax: 559-320-0539
1952559353 — MAXIMINO BRAMBILA MD
Practice Location Address:
604 N MAGNOLIA AVE STE 100
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Practice Fax: 559-320-0539

Directions to “CENTRAL CALIFORNIA FACULTY MEDICAL GROUP, INC. ” Practice Location

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