Provider Demographics
NPI:1083673842
Name:CENTRAL CALIF ENT MEDICAL GROUP
Entity Type:Organization
Organization Name:CENTRAL CALIF ENT MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF ACCTS. RECEIVABLE
Authorized Official - Prefix:
Authorized Official - First Name:SANDI
Authorized Official - Middle Name:
Authorized Official - Last Name:BARTUCCI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-432-3303
Mailing Address - Street 1:1351 E SPRUCE AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3342
Mailing Address - Country:US
Mailing Address - Phone:559-432-3303
Mailing Address - Fax:559-432-1468
Practice Address - Street 1:1351 E SPRUCE AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3342
Practice Address - Country:US
Practice Address - Phone:559-432-3303
Practice Address - Fax:559-432-1468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Multi-Specialty
Not Answered207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
Not Answered208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ49290ZOtherBLUE CROSS
CAZZZ49290ZOtherBLUE SHIELD
CAGR0070230Medicaid
CAZZZ49290ZOtherBLUE SHIELD
CAGR0070230Medicaid