Healthcare Provider Details

I. General information

NPI: 1962316190
Provider Name (Legal Business Name): ASHLEE BREANNA DOUGLAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

7120 N MARKS AVE UNIT
FRESNO CA
93711-0268
US

IV. Provider business mailing address

7120 N MARKS AVE UNIT 110
FRESNO CA
93711-0268
US

V. Phone/Fax

Practice location:
  • Phone: 559-439-5437
  • Fax:
Mailing address:
  • Phone: 559-439-5437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: