Healthcare Provider Details

I. General information

NPI: 1639421597
Provider Name (Legal Business Name): MARIANA ESKANDAR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2012
Last Update Date: 10/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5740 N BLACKSTONE AVE T1417
FRESNO CA
93710-5006
US

IV. Provider business mailing address

5740 N BLACKSTONE AVE T1417
FRESNO CA
93710-5006
US

V. Phone/Fax

Practice location:
  • Phone: 559-431-8622
  • Fax:
Mailing address:
  • Phone: 559-431-8622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number56052
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: