Healthcare Provider Details

I. General information

NPI: 1417309428
Provider Name (Legal Business Name): MAI VUE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2016
Last Update Date: 07/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

258 N BLACKSTONE AVE
FRESNO CA
93701-1913
US

IV. Provider business mailing address

258 N BLACKSTONE AVE
FRESNO CA
93701-1913
US

V. Phone/Fax

Practice location:
  • Phone: 559-274-0299
  • Fax: 559-268-0469
Mailing address:
  • Phone: 559-274-0299
  • Fax: 559-268-0469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: