Healthcare Provider Details

I. General information

NPI: 1457942294
Provider Name (Legal Business Name): MRS. YESENIA HORTENCIA GALVAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS YESENIA HORTENCIA FLORES

II. Dates (important events)

Enumeration Date: 02/02/2021
Last Update Date: 02/02/2021
Certification Date: 02/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7096 N WEST AVE
FRESNO CA
93711-0462
US

IV. Provider business mailing address

121 W VASSAR AVE
FRESNO CA
93705-4650
US

V. Phone/Fax

Practice location:
  • Phone: 559-436-0471
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number90828
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: