Healthcare Provider Details

I. General information

NPI: 1548881873
Provider Name (Legal Business Name): FRESNO INSTITUTE OF NEUROSCIENCE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2020
Last Update Date: 04/28/2020
Certification Date: 04/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1558 E SHADOW CREEK DR
FRESNO CA
93730-3536
US

IV. Provider business mailing address

1968 S COAST HWY STE 550
LAGUNA BEACH CA
92651-3681
US

V. Phone/Fax

Practice location:
  • Phone: 610-349-0686
  • Fax: 151-697-7329
Mailing address:
  • Phone: 151-647-8830
  • Fax: 151-697-7329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MARK STECKER
Title or Position: PRESIDENT
Credential: MD
Phone: 610-349-0686