Healthcare Provider Details

I. General information

NPI: 1972230126
Provider Name (Legal Business Name): GUADALUPE KLISE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GUADALUPE HOFFMAN RN

II. Dates (important events)

Enumeration Date: 08/05/2022
Last Update Date: 08/22/2024
Certification Date: 08/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

782 N MEDICAL CENTER DR E STE 211
CLOVIS CA
93611-6808
US

IV. Provider business mailing address

2625 E DIVISADERO ST
FRESNO CA
93721-1431
US

V. Phone/Fax

Practice location:
  • Phone: 559-451-3676
  • Fax: 559-451-3680
Mailing address:
  • Phone: 559-443-2682
  • Fax: 559-443-2681

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95022539
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: