Healthcare Provider Details

I. General information

NPI: 1356018162
Provider Name (Legal Business Name): BEATRIZ ABUNDIS BACHELOR'S DEGREE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2021
Last Update Date: 12/11/2024
Certification Date: 12/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5325 N FRESNO ST STE 106
FRESNO CA
93710-6849
US

IV. Provider business mailing address

2610 W SHAW LN
FRESNO CA
93711-2775
US

V. Phone/Fax

Practice location:
  • Phone: 209-707-5679
  • Fax:
Mailing address:
  • Phone: 559-437-1114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: