Healthcare Provider Details

I. General information

NPI: 1225453467
Provider Name (Legal Business Name): MILENA CAVALCANTE M. D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2014
Last Update Date: 07/27/2021
Certification Date: 03/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 S LEON S PETERS BLVD
FOWLER CA
93625-2538
US

IV. Provider business mailing address

213 N AMEDEO LN
CLOVIS CA
93611-6107
US

V. Phone/Fax

Practice location:
  • Phone: 559-834-1614
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberMD191711
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number173007
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: