Unknown Individual – Pediatrics Physician, NPI 1083682629

Unknown Individual is a healthcare provider. based in Fresno, California. specializing in Pediatrics Physician. They hold a License No. A66901 (CA). The NPI Number for Unknown Individual is 1083682629

Main info

Organization
Inactive
29 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1083682629
Phone
(559) 436-4500
Address
7471 N FRESNO ST
Deactivation Date
2 March 2021

Doctor Profile

Medical School Name
TEXAS TECH UNIVERSITY HEALTH SCIENCE CENTER SCHOOL OF MEDICINE
Secondary Phone
5596372135
Graduation Year
1997 (29 years ago)
PAC ID
0345238739
Group Practice PAC ID
6507770716
Professional Enrollment ID
I20040504001180
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience19
Completeness75
Years active:0State licenses:1Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • 7471, North Fresno Street, Fresno, Fresno County, California, 93720, United States

    FRESNO, CA 937202457

    Phone: (559) 436-4500

    Fax: (559) 436-0500

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 93720)

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Provider's Procedures

Unknown Individual performs procedures in Pediatrics Physician. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
ALLERGY/IMMUNOLOGYCA95004Injection of allergenic extracts into skin, accessed through the skin255033
ALLERGY/IMMUNOLOGYCA95117Injection of incremental dosages of allergen, 2 or more injections172780

Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 6507770716View full group profile

Reviews

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Frequently asked questions

What is Unknown Individual's NPI number?
Unknown Individual's NPI is 1083682629 — the number used across U.S. healthcare to identify this provider.
Is inactive the same as retired for Unknown Individual?
Inactive registry status can reflect deactivation, consolidation, or data lag.
How would a patient describe Unknown Individual's focus?
For Unknown Individual, the primary taxonomy reads as Pediatrics Physician. Clinical services aligned with this taxonomy classification.
What locale is associated with Unknown Individual?
Directory geography for Unknown Individual centers on Fresno, California.
Does inactive status remove historical data?
Historical rows can remain visible after status changes — read the dates carefully.

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