Healthcare Provider Details

I. General information

NPI: 1982890109
Provider Name (Legal Business Name): RICHARD XAVIER OVALLE JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2007
Last Update Date: 02/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7080 N MARKS AVE SUITE 104
FRESNO CA
93711-0288
US

IV. Provider business mailing address

7080 N MARKS AVE SUITE 104
FRESNO CA
93711-0288
US

V. Phone/Fax

Practice location:
  • Phone: 559-248-8550
  • Fax: 559-248-8555
Mailing address:
  • Phone: 559-248-8550
  • Fax: 559-248-8555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: