Basic Information
| Provider Information | |||||||||
| NPI: | 1679223663 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ADVENTIST FAMILY MEDICINE RESIDENCY TULARE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2059 HILLMAN ST | ||||||||
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| City: | TULARE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932741609 | ||||||||
| CountryCode: | US | ||||||||
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| Address1: | 2059 HILLMAN ST | ||||||||
| Address2: | |||||||||
| City: | TULARE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932741609 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5596050090 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/24/2022 | ||||||||
| LastUpdateDate: | 03/29/2022 | ||||||||
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| AuthorizedOfficialLastName: | MATIAN | ||||||||
| AuthorizedOfficialFirstName: | PATRICK | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | RESIDENT PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 4083329879 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DO | ||||||||
| NPICertificationDate: | 03/29/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.