Healthcare Provider Details

I. General information

NPI: 1013069830
Provider Name (Legal Business Name): FRESNO COUNTY CALIFORNIA CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

851 VAN NESS AVE
FRESNO CA
93721-2637
US

IV. Provider business mailing address

4441 E KINGS CANYON RD
FRESNO CA
93702-3604
US

V. Phone/Fax

Practice location:
  • Phone: 559-488-1318
  • Fax:
Mailing address:
  • Phone: 559-488-1318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateCA

VIII. Authorized Official

Name: MRS. GIANG T NGUYEN
Title or Position: DIRECTOR, FRESNO CO MENTAL HEALTH
Credential:
Phone: 559-253-9180