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General NPI Number Information
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NPI Number | 1487839932
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Entity Type | Organization
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Legal Business Name | UCSF FRESNO MEDICAL GROUP
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Dates
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Enumeration Date | 01/03/2008
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Last Update Date | 05/28/2009
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Provider Practice Location Address
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Address Line | 3313 N HILLIARD ST
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City | FRESNO
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State | CA
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Zip | 93726-5854
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Country | US
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Telephone | 559-227-4810
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Fax | 559-227-4167
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Provider Business Mailing Address
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Address Line | PO BOX 60000 FILE 740522
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City | SAN FRANCISCO
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State | CA
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Zip | 94160-0001
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Country | US
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Telephone | 559-227-4810
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Fax | 559-227-4167
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Authorized Official
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Title or Position | ASSOICATE DEAN
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Name | DR. JOAN VORIS
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Credential | MEDICAL DOCTOR
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Telephone | 559-499-6427
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 20822
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | PSY19509
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License Number State | CA
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