Provider Demographics
NPI:1629334438
Name:MEDICAL GROUPS OF DOWNTOWN FRESNO
Entity Type:Organization
Organization Name:MEDICAL GROUPS OF DOWNTOWN FRESNO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:FAY
Authorized Official - Last Name:MOY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-806-9778
Mailing Address - Street 1:2841 TULARE ST
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93721-1320
Mailing Address - Country:US
Mailing Address - Phone:559-284-7790
Mailing Address - Fax:559-323-1857
Practice Address - Street 1:2841 TULARE ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93721-1320
Practice Address - Country:US
Practice Address - Phone:559-284-7790
Practice Address - Fax:559-323-1857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-05
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG53062302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA3447764OtherCORPORATION NUMBER
CAG53062Medicare UPIN