Provider Demographics
NPI:1366411092
Name:OCCUPATIONAL MEDICAL ASSOCIATES INC.
Entity type:Organization
Organization Name:OCCUPATIONAL MEDICAL ASSOCIATES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/MED DIR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:DONALD
Authorized Official - Last Name:WENDEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-320-2667
Mailing Address - Street 1:5160 N FRESNO ST
Mailing Address - Street 2:102
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-6825
Mailing Address - Country:US
Mailing Address - Phone:559-320-2667
Mailing Address - Fax:559-320-2069
Practice Address - Street 1:5160 N FRESNO ST
Practice Address - Street 2:102
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-6825
Practice Address - Country:US
Practice Address - Phone:559-320-2667
Practice Address - Fax:559-320-2069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA22525207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA85637Medicare UPIN