Healthcare Provider Details

I. General information

NPI: 1275175556
Provider Name (Legal Business Name): MARISELA TALI VU NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2019
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5555 N FRESNO ST
FRESNO CA
93710-6006
US

IV. Provider business mailing address

132 OMAHA AVE
CLOVIS CA
93619-7616
US

V. Phone/Fax

Practice location:
  • Phone: 559-430-8211
  • Fax:
Mailing address:
  • Phone: 765-606-8396
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number95026491
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: