Healthcare Provider Details

I. General information

NPI: 1669712089
Provider Name (Legal Business Name): JUDY XIONG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2013
Last Update Date: 06/15/2022
Certification Date: 06/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

568 E HERNDON AVE STE 201
FRESNO CA
93720-2989
US

IV. Provider business mailing address

568 E HERNDON AVE STE 201
FRESNO CA
93720-2989
US

V. Phone/Fax

Practice location:
  • Phone: 559-228-6600
  • Fax: 559-226-3709
Mailing address:
  • Phone: 559-228-6600
  • Fax: 559-226-3709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95018688
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number95018688
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number9501688
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: