Healthcare Provider Details

I. General information

NPI: 1982538401
Provider Name (Legal Business Name): DEHESA DERMATOLOGY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

978 N TEMPERANCE AVE
CLOVIS CA
93611-8606
US

IV. Provider business mailing address

978 N TEMPERANCE AVE
CLOVIS CA
93611-8606
US

V. Phone/Fax

Practice location:
  • Phone: 559-951-9000
  • Fax: 559-234-6334
Mailing address:
  • Phone: 559-951-9000
  • Fax: 559-234-6334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: LUIS ALBERTO DEHESA
Title or Position: MEDICAL DIRECTOR/OWNER
Credential:
Phone: 559-951-9000