Healthcare Provider Details

I. General information

NPI: 1548869605
Provider Name (Legal Business Name): ASHLEY MARIE HAZELTON RDHAP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2020
Last Update Date: 07/18/2023
Certification Date: 07/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3078 N APRICOT AVE
FRESNO CA
93727-9100
US

IV. Provider business mailing address

1840 SHAW AVE STE 105-11
CLOVIS CA
93611-4078
US

V. Phone/Fax

Practice location:
  • Phone: 559-458-8010
  • Fax:
Mailing address:
  • Phone: 559-825-0096
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberHAP782
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number26940
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: