Healthcare Provider Details

I. General information

NPI: 1396030573
Provider Name (Legal Business Name): JOHN CONRADO KUIVENHOVEN PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2011
Last Update Date: 07/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5241 N MAPLE AVE SUITE 2
FRESNO CA
93740-0001
US

IV. Provider business mailing address

5241 N MAPLE AVE
FRESNO CA
93740-0001
US

V. Phone/Fax

Practice location:
  • Phone: 559-474-4547
  • Fax: 559-905-5824
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSB 94022290
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: