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Organization
CENTRAL CALIFORNIA FACULTY MEDICAL GROUP, INC.
Active
Organization
CENTRAL CALIFORNIA FACULTY MEDICAL GROUP, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KARL P VAN GUNDY MD (PRESIDENT)
(559) 453-5200
Entity
Organization
Contact information
Practice address
1247 E ALLUVIAL AVE, SUITE 101, FRESNO, CA 93720-2686
(559) 431-6226
(559) 440-9005
Mailing address
2625 E DIVISADERO ST, FRESNO, CA 93721-1431
(559) 443-2682
(559) 443-2681
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
—
NULL
2086S0129X
Vascular Surgery Physician
Primary
—
—
213E00000X
Podiatrist
—
NULL
213E00000X
Podiatrist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DC4679
RAILROAD MEDICARE
CA
05
—
GR0014818
—
CA
Enumeration date
02/22/2007
Last updated
11/20/2014
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