Healthcare Provider Details

I. General information

NPI: 1033378559
Provider Name (Legal Business Name): FRESNO COUNTY ADULT OUTPATIENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2008
Last Update Date: 06/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4447 E KINGS CANYON RD
FRESNO CA
93702-3604
US

IV. Provider business mailing address

4441 E KINGS CANYON RD
FRESNO CA
93702-3604
US

V. Phone/Fax

Practice location:
  • Phone: 559-253-9318
  • Fax:
Mailing address:
  • Phone: 559-253-9318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: GIANG T NGUYEN
Title or Position: DIRECTOR
Credential:
Phone: 559-253-9180