Healthcare Provider Details

I. General information

NPI: 1013393339
Provider Name (Legal Business Name): MALEE VANG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2015
Last Update Date: 08/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3103 E CARTWRIGHT AVE
FRESNO CA
93725-9385
US

IV. Provider business mailing address

3103 E CARTWRIGHT AVE
FRESNO CA
93725-9385
US

V. Phone/Fax

Practice location:
  • Phone: 559-498-7100
  • Fax: 559-498-7111
Mailing address:
  • Phone: 559-498-7100
  • Fax: 559-498-7111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: