Healthcare Provider Details

I. General information

NPI: 1205064037
Provider Name (Legal Business Name): FRED H. NAGATA, D.P.M., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2009
Last Update Date: 07/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1191 E HERNDON AVE STE 101
FRESNO CA
93720-3164
US

IV. Provider business mailing address

1191 E HERNDON AVE STE 101
FRESNO CA
93720-3164
US

V. Phone/Fax

Practice location:
  • Phone: 559-435-3039
  • Fax: 559-435-1105
Mailing address:
  • Phone: 559-435-3039
  • Fax: 559-435-1105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberE2516
License Number StateCA

VIII. Authorized Official

Name: DR. FRED HISAO NAGATA
Title or Position: OWNER
Credential: D.P.M.
Phone: 559-435-3039