Healthcare Provider Details

I. General information

NPI: 1134107980
Provider Name (Legal Business Name): LETICIA L TUITE PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2006
Last Update Date: 02/01/2023
Certification Date: 02/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1047 R ST
FRESNO CA
93721-1312
US

IV. Provider business mailing address

7078 N MAPLE AVE 101
FRESNO CA
93720-8007
US

V. Phone/Fax

Practice location:
  • Phone: 559-449-1690
  • Fax: 559-499-1697
Mailing address:
  • Phone: 559-449-8200
  • Fax: 559-449-1227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA16817
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: