Healthcare Provider Details

I. General information

NPI: 1205199585
Provider Name (Legal Business Name): TOM JOE MAEZ PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2012
Last Update Date: 06/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7535 N PALM AVE 101
FRESNO CA
93711-5504
US

IV. Provider business mailing address

7535 N PALM AVE 101
FRESNO CA
93711-5504
US

V. Phone/Fax

Practice location:
  • Phone: 559-432-9800
  • Fax: 559-432-2349
Mailing address:
  • Phone: 559-432-9800
  • Fax: 559-432-2349

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number40006
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: