Healthcare Provider Details

I. General information

NPI: 1174374466
Provider Name (Legal Business Name): DAVID HELZER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2024
Last Update Date: 08/20/2024
Certification Date: 08/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1204 W SHAW AVE # 102
FRESNO CA
93711-3706
US

IV. Provider business mailing address

1204 W SHAW AVE # 102
FRESNO CA
93711-3706
US

V. Phone/Fax

Practice location:
  • Phone: 559-273-2942
  • Fax: 559-860-0130
Mailing address:
  • Phone: 559-273-2942
  • Fax: 559-860-0130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberSUDRC19016
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: