Provider Demographics
NPI:1336287440
Name:GULESSERIAN, DICKRAN H (MD)
Entity Type:Individual
Prefix:DR
First Name:DICKRAN
Middle Name:H
Last Name:GULESSERIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1275 E SPRUCE AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3345
Mailing Address - Country:US
Mailing Address - Phone:559-226-0848
Mailing Address - Fax:559-248-9585
Practice Address - Street 1:1275 E SPRUCE AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3345
Practice Address - Country:US
Practice Address - Phone:559-226-0848
Practice Address - Fax:559-248-9585
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA043475207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0099780Medicaid
CAGR0099780Medicaid
CAZZZ31616ZMedicare ID - Type Unspecified