Healthcare Provider Details

I. General information

NPI: 1043341597
Provider Name (Legal Business Name): COUNTY OF FRESNO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 05/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 E AMERICAN AVE JUVENILE JUSTICE CENTER, MEDICAL SERVICES
FRESNO CA
93725-9235
US

IV. Provider business mailing address

PO BOX 11867 CORRECTIONAL HEALTH - JUVENILE JUSTICE CENTER
FRESNO CA
93775-1867
US

V. Phone/Fax

Practice location:
  • Phone: 559-600-3996
  • Fax: 559-600-7466
Mailing address:
  • Phone: 559-600-3229
  • Fax: 559-600-7687

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVID POMAVILLE
Title or Position: DIRECTOR
Credential: M.B.A., R.E.H.S.
Phone: 559-600-3200