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NPI Code Detail

MEDICARE: MRS. AMELIA SOUDER

MEDICARE: MRS. AMELIA SOUDER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
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General Provider Information

NPI Number : 1790582708
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. AMELIA SOUDER
Provider Business Mailing Address
First Line : 8440 N MILLBROOK AVE APT 102
Second Line :
City : FRESNO
State : CA
Zip : 93720-2156
Country : US
Telephone Number : 559-776-8669
Fax Number :
Provider Business Practice Location Address
First Line : 8440 N MILLBROOK AVE APT 102
Second Line :
City : FRESNO
State : CA
Zip : 93720-2156
Country : US
Telephone Number : 559-776-8669
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/26/2025
Last Update Date : 02/26/2025

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Directions to “ MRS. AMELIA SOUDER ” Practice Location

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