Healthcare Provider Details

I. General information

NPI: 1992580526
Provider Name (Legal Business Name): DEURA AVILA FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2023
Last Update Date: 08/30/2023
Certification Date: 08/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3837 N CLARK ST
FRESNO CA
93726-4806
US

IV. Provider business mailing address

2731 RALL AVE
CLOVIS CA
93611-5042
US

V. Phone/Fax

Practice location:
  • Phone: 877-960-3426
  • Fax:
Mailing address:
  • Phone: 559-310-1164
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95026879
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: