Provider Demographics
NPI:1669889721
Name:TOTAL CARE MEDICAL ASSOCIATES, INC
Entity type:Organization
Organization Name:TOTAL CARE MEDICAL ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:VIPUL
Authorized Official - Middle Name:RAMAN
Authorized Official - Last Name:DEV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:661-327-2101
Mailing Address - Street 1:5361 E KINGS CANYON RD
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93727-4898
Mailing Address - Country:US
Mailing Address - Phone:661-327-2101
Mailing Address - Fax:661-327-2554
Practice Address - Street 1:2901 SILLECT AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93308-6371
Practice Address - Country:US
Practice Address - Phone:661-327-2101
Practice Address - Fax:661-327-2554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-21
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA63639261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1891702122Medicare PIN