Healthcare Provider Details

I. General information

NPI: 1841110582
Provider Name (Legal Business Name): MRS. EDITH MORALES VIVAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3851 N EZIE AVE
FRESNO CA
93727-7925
US

IV. Provider business mailing address

3851 N EZIE AVE
FRESNO CA
93727-7925
US

V. Phone/Fax

Practice location:
  • Phone: 559-363-2190
  • Fax:
Mailing address:
  • Phone: 559-363-2190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number21163
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: