Healthcare Provider Details

I. General information

NPI: 1427544022
Provider Name (Legal Business Name): FABIOLA ALEJANDRA MIESES PUN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2018
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 W CHRISTOFFERSEN PKWY
TURLOCK CA
95382-9547
US

IV. Provider business mailing address

PO BOX 255228
SACRAMENTO CA
95865-5228
US

V. Phone/Fax

Practice location:
  • Phone: 209-632-3909
  • Fax: 209-656-8507
Mailing address:
  • Phone: 800-470-0010
  • Fax: 916-854-6769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number67321
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberC205738
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: