Healthcare Provider Details

I. General information

NPI: 1184049793
Provider Name (Legal Business Name): GREATER FRESNO HEALTH ORGANIZATION INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2014
Last Update Date: 05/01/2024
Certification Date: 05/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4011 N MARKS AVE
FRESNO CA
93722-4555
US

IV. Provider business mailing address

4011 N MARKS AVE
FRESNO CA
93722-4555
US

V. Phone/Fax

Practice location:
  • Phone: 559-860-4925
  • Fax:
Mailing address:
  • Phone: 559-860-4925
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. BLA MOUANOUTOUA
Title or Position: CEO
Credential:
Phone: 559-255-6476