Healthcare Provider Details

I. General information

NPI: 1821538646
Provider Name (Legal Business Name): DEBRA LYNN CALVERT LICENSED ELECTROLOGI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DEBRA LYNN STAPP

II. Dates (important events)

Enumeration Date: 02/27/2017
Last Update Date: 02/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

524 W VARTIKIAN AVE
FRESNO CA
93704-1443
US

IV. Provider business mailing address

524 W VARTIKIAN AVE
FRESNO CA
93704-1443
US

V. Phone/Fax

Practice location:
  • Phone: 559-261-2100
  • Fax:
Mailing address:
  • Phone: 559-261-2100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License NumberL6591
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: