Provider Demographics
NPI:1689856171
Name:CALIFORNIA INDUSTRIAL MEDICINE, INC.
Entity Type:Organization
Organization Name:CALIFORNIA INDUSTRIAL MEDICINE, INC.
Other - Org Name:CALIFORNIA MEDICAL GROUP
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DIRECTOR OF BUSINESS OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:SHELBY
Authorized Official - Middle Name:V
Authorized Official - Last Name:JOBE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:831-212-2123
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:559-435-3696
Mailing Address - Fax:559-435-3698
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:559-435-3696
Practice Address - Fax:559-435-3698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-27
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC12065174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty