Healthcare Provider Details

I. General information

NPI: 1457023350
Provider Name (Legal Business Name): FANNY PEREZ GUTIERREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2021
Last Update Date: 09/29/2021
Certification Date: 09/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 N BLACKSTONE AVE
FRESNO CA
93703-3606
US

IV. Provider business mailing address

1210 N BLACKSTONE AVE
FRESNO CA
93703-3606
US

V. Phone/Fax

Practice location:
  • Phone: 559-445-0694
  • Fax: 559-445-1480
Mailing address:
  • Phone: 559-445-0694
  • Fax: 559-445-1480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number123211
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: