Healthcare Provider Details

I. General information

NPI: 1316866700
Provider Name (Legal Business Name): PATRICK ANDERSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7525 N CEDAR AVE STE 101
FRESNO CA
93720-2689
US

IV. Provider business mailing address

7225 N 1ST ST STE 101&105
FRESNO CA
93720-2986
US

V. Phone/Fax

Practice location:
  • Phone: 888-988-0520
  • Fax:
Mailing address:
  • Phone: 888-988-0520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: