Healthcare Provider Details

I. General information

NPI: 1841102464
Provider Name (Legal Business Name): PARKER STOFAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 N PEACH AVE STE A1
CLOVIS CA
93611-7248
US

IV. Provider business mailing address

2934 E QUINCY AVE
FRESNO CA
93720-4970
US

V. Phone/Fax

Practice location:
  • Phone: 559-578-8500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86416016
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: