Healthcare Provider Details

I. General information

NPI: 1669088258
Provider Name (Legal Business Name): CHONG MANDY HEU FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2020
Last Update Date: 12/07/2020
Certification Date: 12/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2042 KERN ST
FRESNO CA
93721-2008
US

IV. Provider business mailing address

6510 E BUCKEYE AVE
FRESNO CA
93727-6859
US

V. Phone/Fax

Practice location:
  • Phone: 559-400-6420
  • Fax:
Mailing address:
  • Phone: 559-906-0888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number682730
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number682730
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95015989
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: