Healthcare Provider Details

I. General information

NPI: 1275328122
Provider Name (Legal Business Name): AGYAD BAKKOUR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2025
Last Update Date: 08/08/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 N. FRESNO STREET
FRESNO CA
93701
US

IV. Provider business mailing address

1170 SANTA ANA AVE APARTMENT 271
CLOVIS CA
93612
US

V. Phone/Fax

Practice location:
  • Phone: 559-499-6550
  • Fax:
Mailing address:
  • Phone: 708-618-0661
  • 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 State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: