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General NPI Number Information
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NPI Number | 1073721304
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Entity Type | Individual
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Provider Name | LISA SONIA FRUTOS RN, FNP
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Gender | Female
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Dates
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Enumeration Date | 05/18/2007
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Last Update Date | 12/30/2022
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Provider Practice Location Address
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Address Line | 1107 O ST
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City | FIREBAUGH
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State | CA
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Zip | 93622-2224
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Country | US
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Telephone | 559-659-9000
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Fax |
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Provider Business Mailing Address
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Address Line | 1574 ESCALON AVE
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City | CLOVIS
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State | CA
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Zip | 93611-0501
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Country | US
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Telephone | 559-824-1828
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 12078
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License Number State | CA
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