| El Capitan Wound & Diabetic Center Inc | |
|
4747 N 1st St Ste 134 Fresno CA 93726 | |
| (559) 493-5484 | |
| (559) 493-5751 |
| Full Name | El Capitan Wound & Diabetic Center Inc |
|---|---|
| Speciality | Internal Medicine |
| Location | 4747 N 1st St Ste 134, Fresno, California |
| Authorized Official Name and Position | Earl D Fernando (CEO/PRESIDENT/OWNER) |
| Authorized Official Contact | 5594935484 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| El Capitan Wound & Diabetic Center Inc 4747 N 1st St Ste 134 Fresno CA 93726-0589 Ph: (559) 493-5484 | El Capitan Wound & Diabetic Center Inc 4747 N 1st St Ste 134 Fresno CA 93726 Ph: (559) 493-5484 |
| NPI Number | 1326462631 |
|---|---|
| Provider Enumeration Date | 02/06/2014 |
| Last Update Date | 08/21/2018 |
| Medicare PECOS PAC ID | 7618133356 |
|---|---|
| Medicare Enrollment ID | O20120724000501 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326462631 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | G64927 (California) | Primary |
| Provider Name | Earl D Fernando |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1033255021 PECOS PAC ID: 1759278575 Enrollment ID: I20040304000366 |
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