Healthcare Provider Details

I. General information

NPI: 1669017141
Provider Name (Legal Business Name): TINA XIONG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2019
Last Update Date: 11/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1470 W HERNDON AVE
FRESNO CA
93711-0552
US

IV. Provider business mailing address

2328 S EDDY AVE
FRESNO CA
93727-6484
US

V. Phone/Fax

Practice location:
  • Phone: 559-256-2000
  • Fax: 559-256-3000
Mailing address:
  • Phone: 562-256-0552
  • Fax:

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: