Healthcare Provider Details

I. General information

NPI: 1407615370
Provider Name (Legal Business Name): FRESNO WOUND CARE IN HOME SERVICE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2024
Last Update Date: 07/14/2025
Certification Date: 07/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1954 N GATEWAY BLVD STE 102
FRESNO CA
93727-1644
US

IV. Provider business mailing address

1954 N GATEWAY BLVD STE 102
FRESNO CA
93727-1644
US

V. Phone/Fax

Practice location:
  • Phone: 559-475-0274
  • Fax:
Mailing address:
  • Phone: 559-475-0274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. ISLAMBEK TARPANBAEV
Title or Position: CEO
Credential:
Phone: 559-475-0274