Healthcare Provider Details

I. General information

NPI: 1164660353
Provider Name (Legal Business Name): CARMEN MARTELL KOENIG NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CARMEN MARTELL ZUNIGA

II. Dates (important events)

Enumeration Date: 01/27/2009
Last Update Date: 11/15/2023
Certification Date: 11/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1275 E SPRUCE AVE STE 103
FRESNO CA
93720-3372
US

IV. Provider business mailing address

1275 E SPRUCE AVE STE 103
FRESNO CA
93720-3372
US

V. Phone/Fax

Practice location:
  • Phone: 559-432-0716
  • Fax: 559-432-4545
Mailing address:
  • Phone: 559-432-0716
  • Fax: 559-261-4500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP17317
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: