Healthcare Provider Details

I. General information

NPI: 1861851537
Provider Name (Legal Business Name): ESTHER O MCCONVILLE RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2016
Last Update Date: 03/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2740 HERNDON AVE
CLOVIS CA
93611-6813
US

IV. Provider business mailing address

2740 HERNDON AVE
CLOVIS CA
93611-6813
US

V. Phone/Fax

Practice location:
  • Phone: 559-299-2608
  • Fax: 559-299-1421
Mailing address:
  • Phone: 559-299-2608
  • Fax: 559-299-1421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number981406
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: