Healthcare Provider Details

I. General information

NPI: 1992800163
Provider Name (Legal Business Name): JUAN MANUEL ESCUTIA MS, MFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3133 N MILLBROOK AVE
FRESNO CA
93703-1425
US

IV. Provider business mailing address

3133 N MILLBROOK AVE
FRESNO CA
93703-1425
US

V. Phone/Fax

Practice location:
  • Phone: 559-453-8405
  • Fax: 559-453-6733
Mailing address:
  • Phone: 559-453-8405
  • Fax: 559-453-6733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC 42753
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: