NPIMap

Organization Active NPI

Blue Line Medical Corp

  • Vascular Surgery Physician
  • Clovis, CA
National Provider Identifier
1750015616
Registry record updated Jul 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Surgery PhysicianTaxonomy code 2086S0129X
Legal business name
BLUE LINE MEDICAL CORP
Practice address
3120 Willow Ave Ste 101
Clovis, CA 93612-4714
Phone
(559) 370-8694
Fax
(626) 377-4221
NPI assigned
Jul 14, 2022
Last updated
Jul 14, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 14, 2022

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

Authorized official

Name
Dr. Leo L Fong, MDNPI 1215047659
Title
Owner/President
Phone
(559) 370-8694

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular Surgery Physician 2086S0129X Primary

Addresses

Primary practice location

3120 Willow Ave Ste 101
Clovis, CA 93612-4714

Mailing address

1099 E. Champlain Drive
Suite a #186
Fresno, CA 93720
Phone (559) 370-8694

National Provider Directory

National Provider Directory

Locations

3120 Willow Ave
Clovis, CA 93612
Phone (559) 370-8694

1850 Floral Ave
Selma, CA 93662
Phone (559) 721-4910

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1657756800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1657756800000",
    "number": "1750015616",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1099 E. CHAMPLAIN DRIVE",
            "address_2": "SUITE A #186",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "93720",
            "telephone_number": "559-370-8694",
            "fax_number": "626-377-4221"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3120 WILLOW AVE STE 101",
            "city": "CLOVIS",
            "state": "CA",
            "postal_code": "936124714",
            "telephone_number": "559-370-8694",
            "fax_number": "626-377-4221"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE LINE MEDICAL CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-07-14",
        "last_updated": "2022-07-14",
        "certification_date": "2022-07-14",
        "status": "A",
        "authorized_official_last_name": "FONG",
        "authorized_official_first_name": "LEO",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "559-370-8694",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clovis, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.