Organization
GASTROENTEROLOGY AND LIVER DISEASE MEDICAL CENTER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. AUDRA E ORBAKER (ADMINISTRATOR)
(559) 760-9981
Entity
Organization
Contact information
Practice address
7215 N FRESNO ST, #101, FRESNO, CA 93720-2969
(559) 449-0309
(559) 449-0609
Mailing address
7215 N FRESNO ST, #101, FRESNO, CA 93720-2969
(559) 449-0309
(559) 449-0609
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
AS1593001
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
SUR01593F
—
CA
01
—
ZZZH1024Z
BLUE SHIELD
CA
Enumeration date
05/30/2006
Last updated
03/21/2024
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