Healthcare Provider Details

I. General information

NPI: 1295952497
Provider Name (Legal Business Name): RENEE ANTOINETTE BACAS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 01/31/2023
Certification Date: 01/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2719 N AIR FRESNO DR
FRESNO CA
93727-1547
US

IV. Provider business mailing address

2719 N AIR FRESNO DR
FRESNO CA
93727-1547
US

V. Phone/Fax

Practice location:
  • Phone: 678-690-7757
  • Fax: 404-751-5170
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberG76869
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: