Healthcare Provider Details

I. General information

NPI: 1437939360
Provider Name (Legal Business Name): BENJAMIN WILLIAM THORNBURY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2023
Last Update Date: 06/05/2025
Certification Date: 06/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3636 N. FIRST ST. SUITE 162,124,112
FRESNO CA
93726
US

IV. Provider business mailing address

3636 N. FIRST ST. SUITE 162,124,112
FRESNO CA
93726
US

V. Phone/Fax

Practice location:
  • Phone: 559-476-2166
  • Fax:
Mailing address:
  • Phone: 559-476-2166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: