Healthcare Provider Details

I. General information

NPI: 1598343840
Provider Name (Legal Business Name): MIRANDA MERCY BELMONTEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2021
Last Update Date: 02/14/2023
Certification Date: 02/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

496 S BARTON AVE
FRESNO CA
93702-2985
US

IV. Provider business mailing address

3433 W SHAW AVE STE 103
FRESNO CA
93711-3229
US

V. Phone/Fax

Practice location:
  • Phone: 559-860-4422
  • Fax:
Mailing address:
  • Phone: 559-558-4051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: