Healthcare Provider Details

I. General information

NPI: 1144037243
Provider Name (Legal Business Name): JENNIFER DY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2024
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

153 N U ST
FRESNO CA
93701-2438
US

IV. Provider business mailing address

2245 PEACH AVE APT 55
CLOVIS CA
93612-3571
US

V. Phone/Fax

Practice location:
  • Phone: 559-445-9094
  • Fax:
Mailing address:
  • Phone: 559-931-3002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: