Provider Demographics
NPI:1124886882
Name:EXPRESS CARE MEDICAL GROUP, A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:EXPRESS CARE MEDICAL GROUP, A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:MALATE
Authorized Official - Last Name:REDUBLA
Authorized Official - Suffix:
Authorized Official - Credentials:NP-C
Authorized Official - Phone:559-840-2727
Mailing Address - Street 1:807 N VAN NESS AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93728-3425
Mailing Address - Country:US
Mailing Address - Phone:559-840-2727
Mailing Address - Fax:559-578-8899
Practice Address - Street 1:2131 HERNDON AVE STE 103
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93611-6304
Practice Address - Country:US
Practice Address - Phone:559-578-8844
Practice Address - Fax:559-578-8899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-07
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty