Healthcare Provider Details

I. General information

NPI: 1164543773
Provider Name (Legal Business Name): GINNY GAYLE FERNANDEZ N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: GINNY GAYLE DESIMAS

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 05/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7075 N FRESNO ST 102
FRESNO CA
93720-6851
US

IV. Provider business mailing address

190 JORDAN AVE
CLOVIS CA
93611-7086
US

V. Phone/Fax

Practice location:
  • Phone: 559-299-8800
  • Fax: 559-299-9944
Mailing address:
  • Phone: 559-299-9905
  • Fax: 559-299-8839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number280892
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: