Healthcare Provider Details

I. General information

NPI: 1780617217
Provider Name (Legal Business Name): Y LENNY SPIVAK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 09/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

342 N VERMONT AVE
DINUBA CA
93618-1631
US

IV. Provider business mailing address

PO BOX 28915
FRESNO CA
93729-8915
US

V. Phone/Fax

Practice location:
  • Phone: 559-591-7229
  • Fax: 559-596-2085
Mailing address:
  • Phone: 559-253-2800
  • Fax: 559-596-2085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA44707
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: