Healthcare Provider Details

I. General information

NPI: 1780903716
Provider Name (Legal Business Name): VERONICA NDIDI ODITA FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2010
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3707 E SHIELDS AVE
FRESNO CA
93726-7029
US

IV. Provider business mailing address

8680 N GLENN AVE
FRESNO CA
93711-6936
US

V. Phone/Fax

Practice location:
  • Phone: 559-229-9041
  • Fax: 559-268-7518
Mailing address:
  • Phone: 818-280-7620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number19584
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: