Healthcare Provider Details

I. General information

NPI: 1255263315
Provider Name (Legal Business Name): DENISE DAVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1617 E SAGINAW WAY STE 101
FRESNO CA
93704-4458
US

IV. Provider business mailing address

6608 N 3RD ST
FRESNO CA
93710-4028
US

V. Phone/Fax

Practice location:
  • Phone: 559-241-8582
  • Fax:
Mailing address:
  • Phone: 559-519-9276
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: