Healthcare Provider Details

I. General information

NPI: 1053633206
Provider Name (Legal Business Name): MR. DENNIS MALATE REDUBLA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: DENNIS MALATE REDUBLA NP

II. Dates (important events)

Enumeration Date: 02/15/2010
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2131 HERNDON AVE STE 103
CLOVIS CA
93611-6304
US

IV. Provider business mailing address

685 W ALLUVIAL AVE STE 103
FRESNO CA
93711-5779
US

V. Phone/Fax

Practice location:
  • Phone: 559-578-8844
  • Fax: 559-578-8899
Mailing address:
  • Phone: 559-499-1233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95004480
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: