Healthcare Provider Details

I. General information

NPI: 1093389561
Provider Name (Legal Business Name): ESTELLA NICOLE VERDUGO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ESTELLA NICOLE VERDUGO

II. Dates (important events)

Enumeration Date: 05/18/2021
Last Update Date: 05/18/2021
Certification Date: 05/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 N PLEASANT AVE
FRESNO CA
93728-2434
US

IV. Provider business mailing address

1040 N PLEASANT AVE
FRESNO CA
93728-2434
US

V. Phone/Fax

Practice location:
  • Phone: 559-899-0888
  • Fax:
Mailing address:
  • Phone: 559-899-0888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: