Provider Demographics
NPI:1033266184
Name:DIEGO G ALLENDE A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:DIEGO G ALLENDE A MEDICAL CORPORATION
Other - Org Name:DIEGO G ALLENDE A MEDICAL CORPORATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DIEGO
Authorized Official - Middle Name:G
Authorized Official - Last Name:ALLENDE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:559-435-5727
Mailing Address - Street 1:6234 N 1ST ST
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-5446
Mailing Address - Country:US
Mailing Address - Phone:559-435-5727
Mailing Address - Fax:559-435-5503
Practice Address - Street 1:6234 N 1ST ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-5446
Practice Address - Country:US
Practice Address - Phone:559-435-5727
Practice Address - Fax:559-435-5503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2017-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X
CA20A76112083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ26825ZMedicare ID - Type UnspecifiedMEDICARE
CAH30844Medicare UPIN