Provider Demographics
NPI:1871699561
Name:LINET R D'MORIAS M D INC
Entity type:Organization
Organization Name:LINET R D'MORIAS M D INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LINET
Authorized Official - Middle Name:R
Authorized Official - Last Name:D'MORIAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-431-4020
Mailing Address - Street 1:6327 N FRESNO ST
Mailing Address - Street 2:SUITE #104
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-5236
Mailing Address - Country:US
Mailing Address - Phone:559-431-4020
Mailing Address - Fax:559-431-4589
Practice Address - Street 1:1303 E. HERNDON AVE
Practice Address - Street 2:MAIL STOP 35
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-9860
Practice Address - Country:US
Practice Address - Phone:559-431-4020
Practice Address - Fax:559-431-4589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA48021207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA8210934OtherMEDI CAL
ZZZ07634ZMedicare PIN