Healthcare Provider Details

I. General information

NPI: 1023766789
Provider Name (Legal Business Name): OKSANA PHILIPS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2022
Last Update Date: 01/10/2025
Certification Date: 01/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1344 W CLINTON AVE
FRESNO CA
93705-3805
US

IV. Provider business mailing address

6333 N BARCUS AVE
FRESNO CA
93722-3375
US

V. Phone/Fax

Practice location:
  • Phone: 877-960-3426
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberPA60899
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: