Healthcare Provider Details

I. General information

NPI: 1649318338
Provider Name (Legal Business Name): PAUL WITOLD OSTOYA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1095 E WARNER AVE #101
FRESNO CA
93710-4000
US

IV. Provider business mailing address

1095 E WARNER AVE #101
FRESNO CA
93710-4000
US

V. Phone/Fax

Practice location:
  • Phone: 559-435-3567
  • Fax:
Mailing address:
  • Phone: 559-435-3567
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA52252
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: