Healthcare Provider Details

I. General information

NPI: 1689849879
Provider Name (Legal Business Name): LANY SIVONGSAY AVAKIAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LANY SIVONGSAY NP

II. Dates (important events)

Enumeration Date: 04/28/2008
Last Update Date: 10/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6121 N THESTA ST #204
FRESNO CA
93710-8603
US

IV. Provider business mailing address

6121 N THESTA ST #204
FRESNO CA
93710-8603
US

V. Phone/Fax

Practice location:
  • Phone: 559-438-7390
  • Fax: 559-438-7166
Mailing address:
  • Phone: 559-438-7390
  • Fax: 559-438-7166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP17618
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: