Healthcare Provider Details

I. General information

NPI: 1780929406
Provider Name (Legal Business Name): SAINT AGNES MEDICAL PROVIDERS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2012
Last Update Date: 03/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1377 E HERNDON AVE SUITE 104
FRESNO CA
93720-3022
US

IV. Provider business mailing address

1303 E HERNDON AVE MS 945
FRESNO CA
93720-3309
US

V. Phone/Fax

Practice location:
  • Phone: 559-450-7455
  • Fax: 559-450-7473
Mailing address:
  • Phone: 559-450-7098
  • Fax: 559-450-3905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. STEPHEN PAUL SOLDO
Title or Position: OWNER
Credential: M.D.
Phone: 559-450-7098