Healthcare Provider Details

I. General information

NPI: 1386104958
Provider Name (Legal Business Name): JUAN ALFREDO DERAS ESPINOZA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2019
Last Update Date: 01/12/2023
Certification Date: 01/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3875 W BEECHWOOD AVE
FRESNO CA
93711-0795
US

IV. Provider business mailing address

3875 W BEECHWOOD AVE
FRESNO CA
93711-0795
US

V. Phone/Fax

Practice location:
  • Phone: 800-492-4227
  • Fax:
Mailing address:
  • Phone: 800-492-4227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA180065
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: