Healthcare Provider Details

I. General information

NPI: 1891147286
Provider Name (Legal Business Name): YENIFER DUQUE-GOMEZ PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2016
Last Update Date: 09/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3645 W SHAW AVE STE 101
FRESNO CA
93711-3206
US

IV. Provider business mailing address

3645 W SHAW AVE STE 101
FRESNO CA
93711-3206
US

V. Phone/Fax

Practice location:
  • Phone: 559-457-6800
  • Fax: 559-457-6890
Mailing address:
  • Phone: 559-457-6800
  • Fax: 559-457-6890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA53528
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: