Healthcare Provider Details

I. General information

NPI: 1588079255
Provider Name (Legal Business Name): ADITI GIRI MBBS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2014
Last Update Date: 12/31/2024
Certification Date: 12/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7780 N FRESNO ST STE 105
FRESNO CA
93720-2413
US

IV. Provider business mailing address

8609 WESTWOOD CENTER DR STE 110
VIENNA VA
22182-7525
US

V. Phone/Fax

Practice location:
  • Phone: 559-490-2067
  • Fax: 559-222-5126
Mailing address:
  • Phone: 571-409-7082
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0101265015
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number0101265015
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberA162034
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: