Healthcare Provider Details

I. General information

NPI: 1033627179
Provider Name (Legal Business Name): GREATER FRESNO HEALTH ORGANIZATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2018
Last Update Date: 04/29/2024
Certification Date: 07/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4770 N CEDAR AVE
FRESNO CA
93726-1065
US

IV. Provider business mailing address

4770 N CEDAR AVE
FRESNO CA
93726-1065
US

V. Phone/Fax

Practice location:
  • Phone: 559-860-4900
  • Fax: 559-255-7906
Mailing address:
  • Phone: 559-860-4900
  • Fax: 559-255-7906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

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