Provider Demographics
NPI:1114971314
Name:BIO-BEHAVIORAL MEDICAL CLINICS, INC
Entity Type:Organization
Organization Name:BIO-BEHAVIORAL MEDICAL CLINICS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MATEO
Authorized Official - Middle Name:
Authorized Official - Last Name:F. DE SOTO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-437-1111
Mailing Address - Street 1:1060 W SIERRA AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-2063
Mailing Address - Country:US
Mailing Address - Phone:559-437-1111
Mailing Address - Fax:559-437-1118
Practice Address - Street 1:1060 W SIERRA AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-2063
Practice Address - Country:US
Practice Address - Phone:559-437-1111
Practice Address - Fax:559-437-1118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty