Healthcare Provider Details

I. General information

NPI: 1134479793
Provider Name (Legal Business Name): AMERICAN HOME DIAGNOSTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2012
Last Update Date: 09/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7575 N CEDAR AVE 103
FRESNO CA
93720-2693
US

IV. Provider business mailing address

7575 N CEDAR AVE 103
FRESNO CA
93720-2693
US

V. Phone/Fax

Practice location:
  • Phone: 559-916-4433
  • Fax:
Mailing address:
  • Phone: 559-916-4433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: JANET G BAILEY
Title or Position: SOLE MBR
Credential:
Phone: 559-916-4433