Healthcare Provider Details

I. General information

NPI: 1508799974
Provider Name (Legal Business Name): FRESNO INCLUSIVE FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3034 TULARE ST
FRESNO CA
93721-1415
US

IV. Provider business mailing address

3034 TULARE ST
FRESNO CA
93721-1415
US

V. Phone/Fax

Practice location:
  • Phone: 559-918-3986
  • Fax:
Mailing address:
  • Phone: 559-918-3986
  • Fax:

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: DR. JULIE NICOLE
Title or Position: CFO
Credential: MD
Phone: 802-309-1881