Healthcare Provider Details

I. General information

NPI: 1386229631
Provider Name (Legal Business Name): XIXMENA CAROL CUYUCH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2021
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4041 PLAZA DR W
FRESNO CA
93702-1342
US

IV. Provider business mailing address

2940 N FRESNO ST
FRESNO CA
93703-1123
US

V. Phone/Fax

Practice location:
  • Phone: 559-939-5999
  • Fax:
Mailing address:
  • Phone: 559-939-5999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: