Healthcare Provider Details

I. General information

NPI: 1356524177
Provider Name (Legal Business Name): MINERAL KING PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2007
Last Update Date: 12/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 S COURT ST STE D
VISALIA CA
93277-4929
US

IV. Provider business mailing address

1700 S COURT ST STE D
VISALIA CA
93277-4929
US

V. Phone/Fax

Practice location:
  • Phone: 559-732-0637
  • Fax: 559-732-5125
Mailing address:
  • Phone: 559-732-0637
  • Fax: 559-732-5125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number
License Number State

VIII. Authorized Official

Name: MRS. CONNIE FLORES
Title or Position: MEDICAL BILLING SPECIALIST
Credential:
Phone: 559-732-0637