Healthcare Provider Details

I. General information

NPI: 1619266871
Provider Name (Legal Business Name): PAKOU VUE CMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2011
Last Update Date: 03/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3750 N 1ST ST
FRESNO CA
93726-5601
US

IV. Provider business mailing address

3750 N 1ST ST
FRESNO CA
93726-5601
US

V. Phone/Fax

Practice location:
  • Phone: 559-224-8217
  • Fax: 559-224-8291
Mailing address:
  • Phone: 559-224-8217
  • Fax: 559-224-8291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number4948
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: