Healthcare Provider Details

I. General information

NPI: 1952109084
Provider Name (Legal Business Name): PROVERI FRESNO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2025
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2350 W SHAW AVE STE 126
FRESNO CA
93711-3400
US

IV. Provider business mailing address

2350 W SHAW AVE STE 126
FRESNO CA
93711-3400
US

V. Phone/Fax

Practice location:
  • Phone: 209-294-8285
  • Fax:
Mailing address:
  • Phone: 209-294-8285
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: TIGER SAELEE
Title or Position: MANAGING MEMBER
Credential:
Phone: 209-294-8285