Healthcare Provider Details

I. General information

NPI: 1609284892
Provider Name (Legal Business Name): DAVID HOLFORD ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2014
Last Update Date: 10/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2727 N CEDAR AVE
FRESNO CA
93703-2016
US

IV. Provider business mailing address

6542 N ORCHARD ST
FRESNO CA
93710-3913
US

V. Phone/Fax

Practice location:
  • Phone: 559-248-5100
  • Fax:
Mailing address:
  • Phone: 559-284-2243
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: