Healthcare Provider Details

I. General information

NPI: 1063270098
Provider Name (Legal Business Name): NIDIA CRISTAL PAYAN MD, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2024
Last Update Date: 03/13/2024
Certification Date: 03/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6763 N PALM AVE
FRESNO CA
93704-1082
US

IV. Provider business mailing address

PO BOX 25042
FRESNO CA
93729-5042
US

V. Phone/Fax

Practice location:
  • Phone: 323-770-3812
  • Fax:
Mailing address:
  • Phone: 559-892-4500
  • Fax: 559-892-4550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: BETTE STANFORD
Title or Position: ADMINISTRATIVE MANAGER
Credential:
Phone: 559-892-4500