Healthcare Provider Details

I. General information

NPI: 1598768590
Provider Name (Legal Business Name): JOSEPH ALIMASUYA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 12/03/2021
Certification Date: 12/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6777 N WILLOW AVE
FRESNO CA
93710-5900
US

IV. Provider business mailing address

6777 N WILLOW AVE
FRESNO CA
93710-5900
US

V. Phone/Fax

Practice location:
  • Phone: 559-681-2623
  • Fax: 888-730-7357
Mailing address:
  • Phone: 559-681-2623
  • Fax: 888-730-7357

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberA85633
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: