Healthcare Provider Details

I. General information

NPI: 1548803323
Provider Name (Legal Business Name): LISA GONZALES CHAPA FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2019
Last Update Date: 02/11/2025
Certification Date: 02/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1510 N LAFAYETTE AVE
FRESNO CA
93728-1123
US

IV. Provider business mailing address

1111 E SPRUCE AVE STE 431
FRESNO CA
93720-3330
US

V. Phone/Fax

Practice location:
  • Phone: 559-457-6860
  • Fax: 559-457-6859
Mailing address:
  • Phone: 559-450-7449
  • Fax: 559-450-7470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95012023
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: