# CENTRAL CALIFORNIA FACULTY MEDICAL GROUP, INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1669507752
- **Authorized official:** DR. KARL P VAN GUNDY MD (PRESIDENT)
- **Authorized official phone:** (559) 453-5200

## Contact information

- **Practice address:** 1247 E ALLUVIAL AVE, SUITE 101, FRESNO, CA 93720-2686
- **Practice address phone:** (559) 431-6226
- **Practice address fax:** (559) 440-9005
- **Mailing address:** 2625 E DIVISADERO ST, FRESNO, CA 93721-1431
- **Mailing address phone:** (559) 443-2682
- **Mailing address fax:** (559) 443-2681

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2086S0129X | Vascular Surgery Physician | — | NULL | Yes |
| 2086S0129X | Vascular Surgery Physician | — | — | Yes |
| 213E00000X | Podiatrist | — | NULL | — |
| 213E00000X | Podiatrist | — | — | — |

## Other

- **Enumeration date:** 02/22/2007
- **Last updated:** 11/20/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | DC4679 | RAILROAD MEDICARE | CA |
| 05 | — | GR0014818 | — | CA |