Healthcare Provider Details

I. General information

NPI: 1891981619
Provider Name (Legal Business Name): ARAVINDA REDDY KOLAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2007
Last Update Date: 06/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3133 N MILLBROOK AVE
FRESNO CA
93703-1425
US

IV. Provider business mailing address

1600 9TH ST ROOM 150 FISCAL ALLOCATIONS AND ESTIMATES UNIT
SACRAMENTO CA
95814-6414
US

V. Phone/Fax

Practice location:
  • Phone: 559-600-8918
  • Fax:
Mailing address:
  • Phone: 916-651-9475
  • Fax: 916-651-8908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA101112
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: