Healthcare Provider Details

I. General information

NPI: 1689182800
Provider Name (Legal Business Name): NORIKO AOYAMA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2018
Last Update Date: 04/15/2024
Certification Date: 04/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2490 W SHAW AVE STE 101
FRESNO CA
93711-3063
US

IV. Provider business mailing address

2490 W SHAW AVE STE 101
FRESNO CA
93711-3305
US

V. Phone/Fax

Practice location:
  • Phone: 559-226-5683
  • Fax:
Mailing address:
  • Phone: 408-531-7062
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95008164
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: