Healthcare Provider Details

I. General information

NPI: 1689583627
Provider Name (Legal Business Name): JAIME ANNETTE LUSTRE ANGUIANO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 N DOUTY ST
HANFORD CA
93230-3951
US

IV. Provider business mailing address

311 N DOUTY ST
HANFORD CA
93230-3951
US

V. Phone/Fax

Practice location:
  • Phone: 559-583-9300
  • Fax: 559-583-9307
Mailing address:
  • Phone: 559-583-9300
  • Fax: 559-583-9307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: