Healthcare Provider Details

I. General information

NPI: 1215076419
Provider Name (Legal Business Name): ASIAN PACIFIC ISLANDER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 09/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4445 E INYO ST
FRESNO CA
93702-2977
US

IV. Provider business mailing address

5108 E CLINTON WAY STE 108
FRESNO CA
93727-2043
US

V. Phone/Fax

Practice location:
  • Phone: 559-253-9131
  • Fax:
Mailing address:
  • Phone: 559-452-3463
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number000001084
License Number StateCA

VIII. Authorized Official

Name: DAWAN UTECHT
Title or Position: DIR, DBH
Credential:
Phone: 559-600-6895