Healthcare Provider Details

I. General information

NPI: 1659589513
Provider Name (Legal Business Name): CHOR LAO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 01/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 M ST
FRESNO CA
93721-1808
US

IV. Provider business mailing address

539 N VAN NESS AVE
FRESNO CA
93728-3419
US

V. Phone/Fax

Practice location:
  • Phone: 559-264-2700
  • Fax: 559-264-2767
Mailing address:
  • Phone: 559-266-9581
  • Fax: 559-498-0507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberR1255690617
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: