Healthcare Provider Details

I. General information

NPI: 1285247445
Provider Name (Legal Business Name): DONALD VERTREES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2020
Last Update Date: 01/11/2021
Certification Date: 01/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 W 5TH ST
HANFORD CA
93230-5029
US

IV. Provider business mailing address

PO BOX 8054
VISALIA CA
93290-8054
US

V. Phone/Fax

Practice location:
  • Phone: 877-960-3426
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA58404
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: