Healthcare Provider Details

I. General information

NPI: 1821804832
Provider Name (Legal Business Name): OLGA LISSETE FACUNDO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2024
Last Update Date: 12/04/2024
Certification Date: 12/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2751 S BARDELL AVE
FRESNO CA
93706-5307
US

IV. Provider business mailing address

2751 S BARDELL AVE
FRESNO CA
93706-5307
US

V. Phone/Fax

Practice location:
  • Phone: 559-353-1558
  • Fax:
Mailing address:
  • Phone: 559-353-1558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number00986454
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: