Healthcare Provider Details

I. General information

NPI: 1659546471
Provider Name (Legal Business Name): LUIS MIGUEL CASTANEDA BUGARIN B.S
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2008
Last Update Date: 04/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

83 E SHAW AVE SUITE 100
FRESNO CA
93710-7620
US

IV. Provider business mailing address

83 E SHAW AVE SUITE 100
FRESNO CA
93710
US

V. Phone/Fax

Practice location:
  • Phone: 559-439-5437
  • Fax: 559-226-2837
Mailing address:
  • Phone: 559-439-5437
  • Fax: 559-226-2837

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: