Healthcare Provider Details

I. General information

NPI: 1821884610
Provider Name (Legal Business Name): CPP 435SKIN PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2025
Last Update Date: 05/09/2025
Certification Date: 05/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 E SPRUCE AVE STE 207
FRESNO CA
93720-3390
US

IV. Provider business mailing address

1125 E SPRUCE AVE STE 207
FRESNO CA
93720-3390
US

V. Phone/Fax

Practice location:
  • Phone: 559-435-7546
  • Fax: 559-435-4976
Mailing address:
  • Phone: 559-435-7546
  • Fax: 559-435-4976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: JESSICA N PALMER
Title or Position: BILLING MANAGER
Credential:
Phone: 559-892-2030