Healthcare Provider Details

I. General information

NPI: 1528180585
Provider Name (Legal Business Name): ROBB WYER RAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 06/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 E AMERICAN AVE
FRESNO CA
93725-9235
US

IV. Provider business mailing address

3932 E WASHINGTON AVE
FRESNO CA
93702-2247
US

V. Phone/Fax

Practice location:
  • Phone: 559-600-4877
  • Fax:
Mailing address:
  • Phone: 559-600-4877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberRASW0702101336
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: