Healthcare Provider Details

I. General information

NPI: 1730563032
Provider Name (Legal Business Name): COUNTY OF FRESNO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2015
Last Update Date: 07/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3133 N MILLBROOK AVE
FRESNO CA
93703-1425
US

IV. Provider business mailing address

3133 N MILLBROOK AVE
FRESNO CA
93703-1425
US

V. Phone/Fax

Practice location:
  • Phone: 550-600-9180
  • Fax:
Mailing address:
  • Phone: 550-600-9180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberVN199828
License Number StateCA

VIII. Authorized Official

Name: DELORES COX
Title or Position: LVN
Credential:
Phone: 559-600-9180