Healthcare Provider Details

I. General information

NPI: 1023773967
Provider Name (Legal Business Name): SUNNYSIDE REHAB OF FRESNO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2021
Last Update Date: 11/05/2021
Certification Date: 11/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2939 S PEACH AVE
FRESNO CA
93725-9302
US

IV. Provider business mailing address

2939 S PEACH AVE
FRESNO CA
93725-9302
US

V. Phone/Fax

Practice location:
  • Phone: 559-233-6248
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MARIO M MARASIGAN
Title or Position: OWNER
Credential:
Phone: 323-767-3327