Provider Demographics
NPI:1053027227
Name:GAMDUR S. BRAR
Entity type:Organization
Organization Name:GAMDUR S. BRAR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CASAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-675-9400
Mailing Address - Street 1:2339 W CLEVELAND AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:93637-8765
Mailing Address - Country:US
Mailing Address - Phone:559-675-9400
Mailing Address - Fax:559-675-9404
Practice Address - Street 1:2339 W CLEVELAND AVE STE 101
Practice Address - Street 2:
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93637-8765
Practice Address - Country:US
Practice Address - Phone:559-675-9400
Practice Address - Fax:559-675-9404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-30
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C510650Medicaid