Healthcare Provider Details

I. General information

NPI: 1649661620
Provider Name (Legal Business Name): TABITHA FYNAUT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2015
Last Update Date: 02/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7175 N. FIRST ST. SUITE 101
FRESNO CA
93720
US

IV. Provider business mailing address

7175 N. FIRST ST. SUITE 101
FRESNO CA
93720
US

V. Phone/Fax

Practice location:
  • Phone: 559-221-8100
  • Fax: 559-221-8101
Mailing address:
  • Phone: 559-221-8100
  • Fax: 559-221-8101

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: