Healthcare Provider Details

I. General information

NPI: 1629075395
Provider Name (Legal Business Name): ALEX ORLANDO HABIBE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 11/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1383 E HERNDON AVE SUITE 105
FRESNO CA
93720-3302
US

IV. Provider business mailing address

1383 E HERNDON AVE STE 105
FRESNO CA
93720-3302
US

V. Phone/Fax

Practice location:
  • Phone: 559-233-4691
  • Fax:
Mailing address:
  • Phone: 559-233-4691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA91655
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: