Healthcare Provider Details

I. General information

NPI: 1700568078
Provider Name (Legal Business Name): BODY AND MIND HEALTHCARE SERVICES - A NURSING CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2023
Last Update Date: 07/24/2024
Certification Date: 07/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1085 SANDERS AVE
CLOVIS CA
93619-3935
US

IV. Provider business mailing address

1085 SANDERS AVE
CLOVIS CA
93619-3935
US

V. Phone/Fax

Practice location:
  • Phone: 408-449-6623
  • Fax:
Mailing address:
  • Phone: 408-449-6623
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MARCEL FAMOTAR
Title or Position: OWNER
Credential: NP
Phone: 408-449-6623