Organization
BLUE LINE MEDICAL CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LEO L FONG MD (OWNER/PRESIDENT)
(559) 370-8694
Entity
Organization
Contact information
Practice address
3120 WILLOW AVE STE 101, CLOVIS, CA 93612-4714
(559) 370-8694
(626) 377-4221
Mailing address
1099 E. CHAMPLAIN DRIVE, SUITE A #186, FRESNO, CA 93720
(559) 370-8694
(626) 377-4221
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
—
—
Other
Enumeration date
07/14/2022
Last updated
07/14/2022
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