Healthcare Provider Details

I. General information

NPI: 1417511205
Provider Name (Legal Business Name): FELLIPE LIMA NOBRE DE QUEIROZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2019
Last Update Date: 10/10/2022
Certification Date: 10/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40595 WESTLAKE DR
OAKHURST CA
93644-9024
US

IV. Provider business mailing address

40595 WESTLAKE DR
OAKHURST CA
93644-9024
US

V. Phone/Fax

Practice location:
  • Phone: 559-658-8388
  • Fax:
Mailing address:
  • Phone: 559-658-8388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD49719
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberR-11693
License Number StateIA
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA181652
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: