Healthcare Provider Details

I. General information

NPI: 1801303318
Provider Name (Legal Business Name): CURTIS PERRY KERNER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2018
Last Update Date: 01/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2140 MERCED ST
FRESNO CA
93721-1721
US

IV. Provider business mailing address

2140 MERCED ST
FRESNO CA
93721-1721
US

V. Phone/Fax

Practice location:
  • Phone: 559-892-1125
  • Fax:
Mailing address:
  • Phone: 559-892-1125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License NumberE1199895
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: