Healthcare Provider Details

I. General information

NPI: 1932621000
Provider Name (Legal Business Name): MARK FLORENTINO FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2017
Last Update Date: 07/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 VAN DORSTEN AVE
CORCORAN CA
93212-2321
US

IV. Provider business mailing address

231 W NOBLE AVE
VISALIA CA
93277-2631
US

V. Phone/Fax

Practice location:
  • Phone: 559-992-2337
  • Fax:
Mailing address:
  • Phone: 559-635-7100
  • Fax: 559-635-7106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number95006755
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: