Healthcare Provider Details

I. General information

NPI: 1649599366
Provider Name (Legal Business Name): ENAS FAROUK ATTIA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2010
Last Update Date: 08/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 E ALLUVIAL AVE SUITE 105
FRESNO CA
93720-3832
US

IV. Provider business mailing address

1515 E ALLUVIAL AVE SUITE 105
FRESNO CA
93720-3832
US

V. Phone/Fax

Practice location:
  • Phone: 559-322-5515
  • Fax: 559-322-5915
Mailing address:
  • Phone: 559-322-5515
  • Fax: 559-322-5915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA110082
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: