Provider Demographics
NPI:1265477624
Name:CARLOS L. CORDOBA M.D. INC.
Entity Type:Organization
Organization Name:CARLOS L. CORDOBA M.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:L
Authorized Official - Last Name:CORDOBA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-233-3343
Mailing Address - Street 1:703 N FULTON ST
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93728-3405
Mailing Address - Country:US
Mailing Address - Phone:559-233-3343
Mailing Address - Fax:559-233-3350
Practice Address - Street 1:703 N FULTON ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93728-3405
Practice Address - Country:US
Practice Address - Phone:559-233-3343
Practice Address - Fax:559-233-3350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA26887Medicare UPIN
CA00A326750Medicare ID - Type Unspecified