Healthcare Provider Details

I. General information

NPI: 1558956615
Provider Name (Legal Business Name): MISS PAULA DELFINA CAMPOS OLVERA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2021
Last Update Date: 12/07/2024
Certification Date: 12/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3103 E CARTWRIGHT AVE
FRESNO CA
93725-9385
US

IV. Provider business mailing address

3369 E TOWNSEND AVE
FRESNO CA
93702-4162
US

V. Phone/Fax

Practice location:
  • Phone: 559-498-7100
  • Fax:
Mailing address:
  • Phone: 559-612-0140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number694963
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number694963
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: