Healthcare Provider Details

I. General information

NPI: 1972509214
Provider Name (Legal Business Name): DWIGHT W SIEVERT MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 01/17/2020
Certification Date: 01/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7766 N PALM AVE STE 107
FRESNO CA
93711-5734
US

IV. Provider business mailing address

7766 N PALM AVE STE 107
FRESNO CA
93711-5734
US

V. Phone/Fax

Practice location:
  • Phone: 559-435-0800
  • Fax: 559-435-7720
Mailing address:
  • Phone: 559-435-0800
  • Fax: 559-435-7720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberG47593
License Number StateCA

VIII. Authorized Official

Name: MS. SYUZANNA TOROSIAN
Title or Position: ADMINISTRATOR
Credential:
Phone: 559-435-0800