Healthcare Provider Details

I. General information

NPI: 1629991732
Provider Name (Legal Business Name): JUDY MOUA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2615 E CLINTON AVE
FRESNO CA
93703-2223
US

IV. Provider business mailing address

8624 N CEDAR AVE APT 104
FRESNO CA
93720-1825
US

V. Phone/Fax

Practice location:
  • Phone: 559-724-5354
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number737189
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: