Healthcare Provider Details

I. General information

NPI: 1710102058
Provider Name (Legal Business Name): BEE VUE RAS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 11/01/2022
Certification Date: 11/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 M ST
FRESNO CA
93721-1808
US

IV. Provider business mailing address

5773 E CHRISTINE AVE
FRESNO CA
93727-6149
US

V. Phone/Fax

Practice location:
  • Phone: 559-264-2700
  • Fax: 559-264-2767
Mailing address:
  • Phone: 559-253-1216
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number5638
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: