Healthcare Provider Details

I. General information

NPI: 1700288057
Provider Name (Legal Business Name): NOORIE PEDNEKAR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2014
Last Update Date: 10/12/2022
Certification Date: 10/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7257 N FRESNO ST
FRESNO CA
93720-2950
US

IV. Provider business mailing address

7257 N FRESNO ST
FRESNO CA
93720-2950
US

V. Phone/Fax

Practice location:
  • Phone: 559-227-7463
  • Fax: 559-451-3690
Mailing address:
  • Phone: 559-227-7463
  • Fax: 559-451-3690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberA145308
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: