Healthcare Provider Details

I. General information

NPI: 1700804689
Provider Name (Legal Business Name): SAINT AGNES PATHOLOGY MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 03/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1303 E. HERNDON AVENUE
FRESNO CA
93720-3309
US

IV. Provider business mailing address

P.O. BOX 3246
PINEDALE CA
93350-3246
US

V. Phone/Fax

Practice location:
  • Phone: 559-450-3130
  • Fax: 559-450-2035
Mailing address:
  • Phone: 559-450-3130
  • Fax: 559-450-2035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: WEI FANG
Title or Position: AUTHORIZED OFFICIAL
Credential: M.D.
Phone: 559-430-3130