Healthcare Provider Details

I. General information

NPI: 1477950525
Provider Name (Legal Business Name): JAI VUE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2014
Last Update Date: 12/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5291 E WEBSTER AVE
FRESNO CA
93727-2511
US

IV. Provider business mailing address

5291 E WEBSTER AVE
FRESNO CA
93727-2511
US

V. Phone/Fax

Practice location:
  • Phone: 559-385-9220
  • Fax:
Mailing address:
  • Phone: 559-385-9220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License NumberVN276885
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: