Healthcare Provider Details

I. General information

NPI: 1588398069
Provider Name (Legal Business Name): DR. MINA SAMEH DAKRAN ROSE SALIB
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2022
Last Update Date: 11/08/2024
Certification Date: 11/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 E HANFORD ARMONA RD
LEMOORE CA
93245-2132
US

IV. Provider business mailing address

3875 W BEECHWOOD AVE
FRESNO CA
93711-0795
US

V. Phone/Fax

Practice location:
  • Phone: 559-646-6618
  • Fax:
Mailing address:
  • Phone: 559-646-6618
  • Fax: 559-646-3652

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number108751
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: