Basic Information
| Provider Information | |||||||||
| NPI: | 1497874721 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DIABETES AND ENDOCRINE SPECIALTIES INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7085 N CHESTNUT AVE STE 101 | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937200353 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5593239236 | ||||||||
| FaxNumber: | 5593230294 | ||||||||
| Practice Location | |||||||||
| Address1: | 7085 N CHESTNUT | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937203841 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5593239236 | ||||||||
| FaxNumber: | 5593230294 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2007 | ||||||||
| LastUpdateDate: | 12/16/2008 | ||||||||
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| AuthorizedOfficialLastName: | SRIKANTH | ||||||||
| AuthorizedOfficialFirstName: | SUJATHA | ||||||||
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| AuthorizedOfficialTitleorPosition: | PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 5593230294 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | A79529 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 00A795290 | 05 | CA | MEDICAID |