Healthcare Provider Details

I. General information

NPI: 1003828948
Provider Name (Legal Business Name): BISHOP PEDIATRICS AND ALLERGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 04/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

152 PIONEER LN STE H
BISHOP CA
93514-2563
US

IV. Provider business mailing address

PO BOX 34120
RENO NV
89533-4120
US

V. Phone/Fax

Practice location:
  • Phone: 760-873-6373
  • Fax: 760-873-3266
Mailing address:
  • Phone: 760-873-6373
  • Fax: 760-873-3266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0201X
TaxonomyPediatric Allergy/Immunology Physician
License NumberA8738
License Number StateCA

VIII. Authorized Official

Name: CHARLOTTE HELVIE
Title or Position: PROVIDER
Credential: M.D.
Phone: 760-873-6373