Healthcare Provider Details

I. General information

NPI: 1164015046
Provider Name (Legal Business Name): STEVE ALLEN FRISBY RNFA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2021
Last Update Date: 02/11/2021
Certification Date: 02/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 VALLEY CHILDRENS PL
MADERA CA
93636-8762
US

IV. Provider business mailing address

2210 E TICONDEROGA DR
FRESNO CA
93720-4646
US

V. Phone/Fax

Practice location:
  • Phone: 559-353-3000
  • Fax:
Mailing address:
  • Phone: 559-287-6694
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number615484
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: