Healthcare Provider Details

I. General information

NPI: 1326628736
Provider Name (Legal Business Name): LUIS ESPIRIDION ZARAZUA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2021
Last Update Date: 04/09/2021
Certification Date: 04/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 O ST STE 202
FRESNO CA
93721-1828
US

IV. Provider business mailing address

1350 O ST STE 202
FRESNO CA
93721-1828
US

V. Phone/Fax

Practice location:
  • Phone: 559-369-4625
  • Fax: 559-369-7259
Mailing address:
  • Phone: 559-369-4625
  • Fax: 559-369-7259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95016734
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: