Dr. Soghomonian'S Medical Clinic, Inc.
Organization Active NPI Primary Care Clinic/Center · Sanger, CA
NPI 1770736712 · NPPES record last updated Nov 3, 2008
Key facts
- NPI
- 1770736712
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Primary Care Clinic/Center 261QP2300X
- License
- A50159 (CA)
- Legal business name
- DR. SOGHOMONIAN'S MEDICAL CLINIC, INC.
- Practice address
- 2570 Jensen Ave
Suite #117
Sanger, CA 93657-2269 - Phone
- (559) 875-2601
- Fax
- (559) 261-0596
- NPI assigned
- Nov 3, 2008
- Organization subpart
- No
Authorized official
- Name
- Dr. Ara K. Soghomonian, M.D.
- Title
- President
- Phone
- (559) 875-2601
Practitioners 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20081104000217 | CA | Part B Supplier - Clinic/Group Practice | 2264591429 |
Receives reassigned benefits from 1 practitioner Practice locations: Fresno, CA; Sanger, CA |
National Provider Directory
Locations
3030 N Fresno St
Fresno, CA 93703
Phone (559) 227-1622
4420 N 1st St
Ste 123
Fresno, CA 93726
Phone (559) 231-5366
2645 Merced St
Fresno, CA 93721
Phone (559) 264-8642
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Care Clinic/Center | 261QE0002X | A50159 | CA | |
| Primary Care Clinic/Center | 261QP2300X | A50159 | CA | Yes |
Addresses
Primary practice location
2570 Jensen Ave
Suite #117
Sanger, CA 93657-2269
Mailing address
2570 Jensen Ave
Suite #117
Sanger, CA 93657-2269
Phone (559) 875-2601
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000A5015 | Medicaid | CA |
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All providers in Sanger, CA · Primary Care Clinic/Center in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 3, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.