Healthcare Provider Details

I. General information

NPI: 1215473343
Provider Name (Legal Business Name): MR. DAVID MOTON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2017
Last Update Date: 01/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4910 E ASHLAN AVE STE 118
FRESNO CA
93726-3021
US

IV. Provider business mailing address

535 S JOSEPH AVE
KERMAN CA
93630-8935
US

V. Phone/Fax

Practice location:
  • Phone: 559-256-4474
  • Fax:
Mailing address:
  • Phone: 949-973-8269
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: