Healthcare Provider Details

I. General information

NPI: 1821438920
Provider Name (Legal Business Name): FERNANDO RUBEN ESCALANTE MFTI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2013
Last Update Date: 05/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5168 N BLYTHE AVE STE 101
FRESNO CA
93722-6478
US

IV. Provider business mailing address

1630 E SHAW AVE, SUITE 150
FRESNO CA
93710
US

V. Phone/Fax

Practice location:
  • Phone: 559-248-8500
  • Fax:
Mailing address:
  • Phone: 559-240-0878
  • Fax: 559-248-8555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: