Healthcare Provider Details

I. General information

NPI: 1619981933
Provider Name (Legal Business Name): JANICE STAIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 S ORANGE AVE
FRESNO CA
93702-3463
US

IV. Provider business mailing address

PO BOX 1559
BAKERSFIELD CA
93302-1559
US

V. Phone/Fax

Practice location:
  • Phone: 559-457-5400
  • Fax: 559-457-5491
Mailing address:
  • Phone: 661-635-3050
  • Fax: 661-635-3070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberG78093
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: