Healthcare Provider Details

I. General information

NPI: 1497803837
Provider Name (Legal Business Name): VICTORIA MONTUFAR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 03/22/2023
Certification Date: 03/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 E LOCUST AVE STE 101
FRESNO CA
93720-2928
US

IV. Provider business mailing address

4229 E CLINTON AVE
FRESNO CA
93703-2612
US

V. Phone/Fax

Practice location:
  • Phone: 559-244-9696
  • Fax: 559-225-5703
Mailing address:
  • Phone: 559-244-9696
  • Fax: 559-225-5703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number51937
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: