Healthcare Provider Details

I. General information

NPI: 1487268967
Provider Name (Legal Business Name): JULIET REGIS VISTA CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2020
Last Update Date: 03/24/2023
Certification Date: 03/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7300 N FRESNO ST
FRESNO CA
93720-2942
US

IV. Provider business mailing address

4033 MORRISON WAY
ROSEVILLE CA
95747-8789
US

V. Phone/Fax

Practice location:
  • Phone: 559-448-2324
  • Fax:
Mailing address:
  • Phone: 562-761-3282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95017389
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number3805
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: