Healthcare Provider Details

I. General information

NPI: 1669789178
Provider Name (Legal Business Name): MR. ENNIO CIPANI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2010
Last Update Date: 09/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28050 ROAD 148
VISALIA CA
93292-9297
US

IV. Provider business mailing address

2637 W BURREL AVE
VISALIA CA
93291-4511
US

V. Phone/Fax

Practice location:
  • Phone: 559-747-3984
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number7668
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: