Healthcare Provider Details

I. General information

NPI: 1629903190
Provider Name (Legal Business Name): BRISSIA ARIANA INFANTE-GOMEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 FULTON ST STE 200
FRESNO CA
93721-1646
US

IV. Provider business mailing address

9100 HIGHWAY 145
MADERA CA
93637-9502
US

V. Phone/Fax

Practice location:
  • Phone: 559-348-9225
  • Fax:
Mailing address:
  • Phone: 559-975-6363
  • 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: