Healthcare Provider Details

I. General information

NPI: 1093898348
Provider Name (Legal Business Name): COUNTY OF FRESNO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 10/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 FULTON MALL IMMUNIZATION CLINIC,1ST FLOOR
FRESNO CA
93721-1915
US

IV. Provider business mailing address

PO BOX 11800 6TH FLOOR
FRESNO CA
93775-1800
US

V. Phone/Fax

Practice location:
  • Phone: 559-600-3281
  • Fax: 559-600-7726
Mailing address:
  • Phone: 559-600-6415
  • Fax: 559-600-7692

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP0905X
TaxonomyState or Local Public Health Clinic/Center
License Number
License Number StateCA

VIII. Authorized Official

Name: MR. DAVID POMAVILLE
Title or Position: DIRECTOR
Credential: M.B.A., R.E.H.S.
Phone: 559-600-3200