NPIMap

Individual provider Active NPI

Hipolito Gallardo Mariano Jr., M.D

  • General Practice Physician
  • Fresno, CA
National Provider Identifier
1376685685
Registry record updated Apr 20, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
A88903 Issued in CA
Practice address
3121 E Olive Ave
Fresno, CA 93702-1030
Phone
(559) 412-4927
Fax
(559) 493-5028
NPI assigned
Feb 13, 2007
Last updated
Apr 20, 2016By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X A88903 CA Primary
Pediatrics Physician 208000000X A88903 CA

Addresses

Primary practice location

3121 E Olive Ave
Fresno, CA 93702-1030

Mailing address

3121 E Olive Ave
Fresno, CA 93702-1030
Phone (559) 412-4927

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070801000612 CA Practitioner - Family PracticePractitioner - General PracticePractitioner - Pediatric Medicine 2062503337 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1986
Medicare assignment
May accept Medicare assignment
Group practices

Practice addresses (Care Compare)

2928 E Cesar E Chavez Ave
Los Angeles, CA 90033-3110
Phone (323) 266-6700

5320 Hwy 49 N
Suite 1 3
Mariposa, CA 95338-9588
Phone (209) 966-2344

600 W I St
Suite C
Los Banos, CA 93635-3460
Phone (209) 710-4934

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
88903CAMDClinical Social Worker
A88903CAMDGeneral Practice Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Aspire Medical and Behavioral Medical Group, Inc. Current Accepting new patients
Community Health Centers of America CurrentSince Nov 4, 2024 Accepting new patients
Community Health Centers of America CurrentSince Nov 4, 2024 Accepting new patients
Trinity Medical Group Inc General Practice CurrentSince Apr 5, 2020 Accepting new patients
Ideal Urgent Care a Medical Corporation PastSince Jul 30, 2017 Accepting new patients
Expedite Urgent Care PastSince Nov 1, 2023 Accepting new patients
Neighborhood Walk in Clinic PastSince Mar 28, 2013 Accepting new patients

Locations

600 W I St
Ste C
Los Banos, CA 93635
Phone (209) 710-4934

733 3rd St
Mc Farland, CA 93250
Phone (661) 792-3097

Organizations & group practices 10

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 9

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1171324800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1461110400000",
    "number": "1376685685",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3121 E OLIVE AVE",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937021030",
            "telephone_number": "559-412-4927",
            "fax_number": "559-493-5028"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3121 E OLIVE AVE",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937021030",
            "telephone_number": "559-412-4927",
            "fax_number": "559-493-5028"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARIANO",
        "first_name": "HIPOLITO",
        "middle_name": "GALLARDO",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "M.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-13",
        "last_updated": "2016-04-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "CA",
            "license": "A88903",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "A88903",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fresno, CA

Sources for this page

Verify at the official NPI Registry.