Healthcare Provider Details

I. General information

NPI: 1447967674
Provider Name (Legal Business Name): HECTOR ARMANDO CERDA JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2022
Last Update Date: 12/20/2022
Certification Date: 12/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7120 N MARKS AVE STE 110
FRESNO CA
93711-0268
US

IV. Provider business mailing address

7120 N MARKS AVE STE 110
FRESNO CA
93711-0268
US

V. Phone/Fax

Practice location:
  • Phone: 559-439-5437
  • Fax:
Mailing address:
  • Phone: 559-558-4051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number79352
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: