Healthcare Provider Details

I. General information

NPI: 1346864600
Provider Name (Legal Business Name): MARIA LUISA KITONGAN AKIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARIA LUISA PALANGEO KITONGAN

II. Dates (important events)

Enumeration Date: 06/02/2020
Last Update Date: 06/02/2020
Certification Date: 06/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2615 E CLINTON AVE
FRESNO CA
93703-2223
US

IV. Provider business mailing address

6796 E AMHERST AVE
FRESNO CA
93727-1450
US

V. Phone/Fax

Practice location:
  • Phone: 559-225-6100
  • Fax:
Mailing address:
  • Phone: 559-908-6450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number747117
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: