Healthcare Provider Details

I. General information

NPI: 1609475318
Provider Name (Legal Business Name): COTY WASHINGTON-ALLEN EMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/22/2020
Last Update Date: 10/22/2020
Certification Date: 10/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 W BELGRAVIA AVE
FRESNO CA
93706-3909
US

IV. Provider business mailing address

377 W WARNER AVE APT 101
FRESNO CA
93704-1262
US

V. Phone/Fax

Practice location:
  • Phone: 559-265-2000
  • Fax:
Mailing address:
  • Phone: 760-577-8730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License NumberE147743
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: