Provider Demographics
NPI:1669547345
Name:FRESNO SHIELDS MEDICAL CENTER INC
Entity type:Organization
Organization Name:FRESNO SHIELDS MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:K
Authorized Official - Last Name:ATMAJIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-227-1622
Mailing Address - Street 1:3030 N FRESNO ST
Mailing Address - Street 2:SUITE # 101
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93703
Mailing Address - Country:US
Mailing Address - Phone:559-227-1622
Mailing Address - Fax:559-227-7668
Practice Address - Street 1:3030 N FRESNO ST
Practice Address - Street 2:SUITE # 101
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93703
Practice Address - Country:US
Practice Address - Phone:559-227-1622
Practice Address - Fax:559-227-7668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0101280Medicaid
CAZZZ324172Medicare ID - Type Unspecified