Healthcare Provider Details

I. General information

NPI: 1578669511
Provider Name (Legal Business Name): ORATHAI SANGRUJIVETH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 07/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1122 S ST SUITE 102
FRESNO CA
93721-1430
US

IV. Provider business mailing address

1122 S ST SUITE 102
FRESNO CA
93721-1430
US

V. Phone/Fax

Practice location:
  • Phone: 559-268-1737
  • Fax: 559-268-1738
Mailing address:
  • Phone: 559-268-1737
  • Fax: 559-268-1738

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA41562
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: