Healthcare Provider Details

I. General information

NPI: 1902839608
Provider Name (Legal Business Name): KRISTIN HIBBARD PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7341 N 1ST ST STE 110
FRESNO CA
93720-2948
US

IV. Provider business mailing address

8839 N CEDAR AVE
FRESNO CA
93720-1832
US

V. Phone/Fax

Practice location:
  • Phone: 559-292-6065
  • Fax: 559-438-1051
Mailing address:
  • Phone: 559-436-1000
  • Fax: 559-354-4235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY19414
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: