Provider Demographics
NPI:1992710552
Name:FRESNO WOMEN'S MEDICAL GROUP, INC.
Entity type:Organization
Organization Name:FRESNO WOMEN'S MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN-SOLE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:MONICA
Authorized Official - Last Name:KOPACZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-322-2900
Mailing Address - Street 1:726 N. MEDICAL CENTER DRIVE EAST
Mailing Address - Street 2:SUITE 221
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-6886
Mailing Address - Country:US
Mailing Address - Phone:559-322-2900
Mailing Address - Fax:559-324-8793
Practice Address - Street 1:726 N. MEDICAL CENTER DRIVE EAST
Practice Address - Street 2:SUITE 221
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93611-6886
Practice Address - Country:US
Practice Address - Phone:559-322-2900
Practice Address - Fax:559-324-8793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1750703237Medicaid
CAZZZ14675ZMedicare ID - Type Unspecified