Healthcare Provider Details

I. General information

NPI: 1083051197
Provider Name (Legal Business Name): VA CENTRAL CALIFORNIA HEALTH CARE SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2013
Last Update Date: 05/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2615 E CLINTON AVE
FRESNO CA
93703-2223
US

IV. Provider business mailing address

2615 E CLINTON AVE
FRESNO CA
93703-2223
US

V. Phone/Fax

Practice location:
  • Phone: 559-225-6100
  • Fax: 559-228-5377
Mailing address:
  • Phone: 559-225-6100
  • Fax: 559-228-5377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number22334
License Number StateCA

VIII. Authorized Official

Name: VERONCA BARRAGAN
Title or Position: NURSE PRACTITIONER
Credential: NP
Phone: 559-225-6100