Healthcare Provider Details

I. General information

NPI: 1841925310
Provider Name (Legal Business Name): MIGUEL PIEDRA HERNANDEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2022
Last Update Date: 07/19/2022
Certification Date: 07/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4250 E TULARE ST
FRESNO CA
93702-3037
US

IV. Provider business mailing address

6923 E ATCHISON ST
FRESNO CA
93727-1177
US

V. Phone/Fax

Practice location:
  • Phone: 559-741-3765
  • Fax:
Mailing address:
  • Phone: 559-741-3765
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: