Healthcare Provider Details

I. General information

NPI: 1972421584
Provider Name (Legal Business Name): NIDIA ANABELLA FLUENCE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 E VINE ST
LODI CA
95240-3148
US

IV. Provider business mailing address

1412 AVENIDA DEL RIO
MODESTO CA
95356-8888
US

V. Phone/Fax

Practice location:
  • Phone: 209-331-7000
  • Fax:
Mailing address:
  • Phone: 704-787-5612
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number22089
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: