Organization
NORTHWEST PHYSICIANS MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LISA E JELINEK (ADMINISTRATOR)
(559) 271-6365
Entity
Organization
Contact information
Practice address
4770 W HERNDON AVE, FRESNO, CA 93722-8401
(559) 271-6365
(559) 271-6326
Mailing address
4770 W HERNDON AVE, FRESNO, CA 93722-8401
(559) 271-6365
(559) 271-6326
Taxonomy
Speciality
Code
Description
License number
State
173000000X
Legal Medicine
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CC6650
MEDICARE RR
CA
05
—
GR0064290
—
CA
Enumeration date
02/27/2006
Last updated
12/20/2007
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