Healthcare Provider Details

I. General information

NPI: 1538259551
Provider Name (Legal Business Name): COUNTY OF FRESNO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 05/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 E ASHLAN AVE
FRESNO CA
93704-3518
US

IV. Provider business mailing address

PO BOX 11867 CMS-GINGSBURG, 2ND FLOOR
FRESNO CA
93775-1867
US

V. Phone/Fax

Practice location:
  • Phone: 559-248-7120
  • Fax: 559-224-8870
Mailing address:
  • Phone: 559-600-3300
  • Fax: 559-600-7713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

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