Provider Demographics
NPI:1881792208
Name:GARDIKAS, VASSI ANN (MD)
Entity type:Individual
Prefix:
First Name:VASSI
Middle Name:ANN
Last Name:GARDIKAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1125 EAST SPRUCE AVENUE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3330
Mailing Address - Country:US
Mailing Address - Phone:559-450-3901
Mailing Address - Fax:559-450-3903
Practice Address - Street 1:1125 EAST SPRUCE AVENUE
Practice Address - Street 2:SUITE 101
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3330
Practice Address - Country:US
Practice Address - Phone:559-450-3901
Practice Address - Fax:559-450-3903
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2013-02-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG65732208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
F34545Medicare UPIN