Provider Demographics
NPI:1043237977
Name:INTERNAL MEDICINE ASSOCIATES OF FRESNO
Entity Type:Organization
Organization Name:INTERNAL MEDICINE ASSOCIATES OF FRESNO
Other - Org Name:IMA OF FRESNO
Other - Org Type:Other Name
Authorized Official - Title/Position:HUMAN RESOURCES/BUSINESS OFC ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:KIMMARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:VERDIALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-435-2630
Mailing Address - Street 1:1379 E HERNDON AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3309
Mailing Address - Country:US
Mailing Address - Phone:559-435-2630
Mailing Address - Fax:559-435-4319
Practice Address - Street 1:1379 E HERNDON AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3309
Practice Address - Country:US
Practice Address - Phone:559-435-2630
Practice Address - Fax:559-435-4319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ79325ZMedicare ID - Type Unspecified