# BLUE LINE MEDICAL CORP

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

## Provider details

- **NPI number:** 1750015616
- **Authorized official:** DR. LEO L FONG MD (OWNER/PRESIDENT)
- **Authorized official phone:** (559) 370-8694

## Contact information

- **Practice address:** 3120 WILLOW AVE STE 101, CLOVIS, CA 93612-4714
- **Practice address phone:** (559) 370-8694
- **Practice address fax:** (626) 377-4221
- **Mailing address:** 1099 E. CHAMPLAIN DRIVE, SUITE A \#186, FRESNO, CA 93720
- **Mailing address phone:** (559) 370-8694
- **Mailing address fax:** (626) 377-4221

## Taxonomy

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

## Other

- **Enumeration date:** 07/14/2022
- **Last updated:** 07/14/2022