Healthcare Provider Details

I. General information

NPI: 1487839932
Provider Name (Legal Business Name): UCSF FRESNO MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2008
Last Update Date: 05/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3313 N HILLIARD ST
FRESNO CA
93726-5854
US

IV. Provider business mailing address

PO BOX 60000 FILE 740522
SAN FRANCISCO CA
94160-0001
US

V. Phone/Fax

Practice location:
  • Phone: 559-227-4810
  • Fax: 559-227-4167
Mailing address:
  • Phone: 559-227-4810
  • Fax: 559-227-4167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number20822
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPSY19509
License Number StateCA

VIII. Authorized Official

Name: DR. JOAN VORIS
Title or Position: ASSOICATE DEAN
Credential: MEDICAL DOCTOR
Phone: 559-499-6427