Provider Demographics
NPI:1972975035
Name:FRESNO MULTI-SPECIALTY CLINIC
Entity Type:Organization
Organization Name:FRESNO MULTI-SPECIALTY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RON
Authorized Official - Middle Name:Y
Authorized Official - Last Name:GOLDSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-289-5490
Mailing Address - Street 1:5293 N 1ST ST
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-7007
Mailing Address - Country:US
Mailing Address - Phone:559-761-0632
Mailing Address - Fax:559-353-2773
Practice Address - Street 1:5293 N 1ST ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-7007
Practice Address - Country:US
Practice Address - Phone:559-761-0632
Practice Address - Fax:559-353-2773
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRESNO GOLD MEDICAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-10-28
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG79669207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Multi-Specialty