Healthcare Provider Details

I. General information

NPI: 1487233169
Provider Name (Legal Business Name): DONNA XIONG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2021
Last Update Date: 06/17/2021
Certification Date: 06/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4879 E KINGS CANYON RD
FRESNO CA
93727-3811
US

IV. Provider business mailing address

5432 E INDIANAPOLIS AVE
FRESNO CA
93727-7140
US

V. Phone/Fax

Practice location:
  • Phone: 559-255-8395
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: