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General NPI Number Information
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NPI Number | 1407114796
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Entity Type | Individual
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Provider Name | MARY ZHITNIKOVA D.O.
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Gender | Female
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Dates
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Enumeration Date | 04/25/2012
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Last Update Date | 09/12/2017
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Provider Practice Location Address
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Address Line | 1303 E HERNDON AVE
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City | FRESNO
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State | CA
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Zip | 93720-3309
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Country | US
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Telephone | 559-450-3000
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Fax |
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Provider Business Mailing Address
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Address Line | 2100 POWELL ST STE 900
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City | EMERYVILLE
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State | CA
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Zip | 94608-1844
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Country | US
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Telephone |
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 25MB09693600
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 279835
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | DO.1595
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License Number State | AL
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Taxonomy #4
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 20A14337
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License Number State | CA
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Taxonomy #5
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 20A14337
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License Number State | CA
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