Healthcare Provider Details

I. General information

NPI: 1144387143
Provider Name (Legal Business Name): JULIE MICHELE FRASER RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 11/30/2021
Certification Date: 11/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7300 N FRESNO ST
FRESNO CA
93720-2941
US

IV. Provider business mailing address

10258 N FOWLER AVE
CLOVIS CA
93619-9530
US

V. Phone/Fax

Practice location:
  • Phone: 559-448-2304
  • Fax: 559-448-5460
Mailing address:
  • Phone: 559-779-0479
  • Fax: 559-448-5460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number717742
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: