Healthcare Provider Details

I. General information

NPI: 1861181703
Provider Name (Legal Business Name): SETH FALLEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2023
Last Update Date: 02/24/2025
Certification Date: 02/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

191 E POLK ST
COALINGA CA
93210-2311
US

IV. Provider business mailing address

PO BOX 580
LEMOORE CA
93245-0580
US

V. Phone/Fax

Practice location:
  • Phone: 559-935-2100
  • Fax: 559-935-4100
Mailing address:
  • Phone: 559-386-4500
  • Fax: 559-282-5090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: