Healthcare Provider Details

I. General information

NPI: 1275612673
Provider Name (Legal Business Name): VALLEY CHILDREN'S HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2006
Last Update Date: 01/14/2025
Certification Date: 01/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5085 E MCKINLEY AVE
FRESNO CA
93727-1964
US

IV. Provider business mailing address

5085 E MCKINLEY AVE
FRESNO CA
93727-1964
US

V. Phone/Fax

Practice location:
  • Phone: 559-353-7125
  • Fax: 559-353-7461
Mailing address:
  • Phone: 559-353-7125
  • Fax: 559-353-7460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License NumberPHY44810
License Number StateCA

VIII. Authorized Official

Name: MS. TINA MYCROFT
Title or Position: SENIOR VP & CFO
Credential:
Phone: 559-353-7238