Healthcare Provider Details

I. General information

NPI: 1336409820
Provider Name (Legal Business Name): JOCELYN ANN MIZUNAKA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JOCELYN ANN FONG MD

II. Dates (important events)

Enumeration Date: 05/18/2012
Last Update Date: 07/08/2020
Certification Date: 07/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1570 7TH STREET
SANGER CA
93657
US

IV. Provider business mailing address

3875 W BEECHWOOD AVE
FRESNO CA
93711-0795
US

V. Phone/Fax

Practice location:
  • Phone: 559-875-0557
  • Fax: 559-875-0575
Mailing address:
  • Phone: 559-875-0557
  • Fax: 559-875-0575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number18062
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: