Main Source Medical LLC

Primary specialty

Nursing Care AgencyTaxonomy code 251J00000X

Legal business name

MAIN SOURCE MEDICAL LLC

Practice address

2155 E Trenton Ave
Fresno, CA 93720-3924

Phone

(805) 453-0191

NPI assigned

Aug 19, 2024

Organization subpart

No

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

Authorized official

Name

Sandra Denise Ibrahim, REGISTERED NURSE

Title

Ceo

Phone

(800) 601-6571

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1724025600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724025600000",
    "number": "1801628680",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2155 E TRENTON AVE",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937203924",
            "telephone_number": "805-453-0191"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2155 E TRENTON AVE",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937203924",
            "telephone_number": "805-453-0191"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAIN SOURCE MEDICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-08-19",
        "last_updated": "2024-08-19",
        "certification_date": "2024-08-19",
        "status": "A",
        "authorized_official_last_name": "IBRAHIM",
        "authorized_official_first_name": "SANDRA",
        "authorized_official_middle_name": "DENISE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "800-601-6571",
        "authorized_official_credential": "REGISTERED NURSE"
    },
    "taxonomies": [
        {
            "code": "251J00000X",
            "taxonomy_group": "",
            "desc": "Nursing Care",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Promila M Mahtab, R.N.
• Anh Van Mai, MSW
• Loc Mai, DC
• Vinh Xuan Mai, DDS
• Amy Maier, PA-C
• Leann Mainis
• Michele Meime Maison-Fomotar, MD
• Manocher Majidzadeh, MS-LMFT
• Alexander L Majors, M.D.
• Jannetta Majors

• Nursing Care Agency in Fresno, CA
• Providers in Fresno, CA by specialty
• Nursing Care Agency in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2024; 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.