=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508799974
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FRESNO INCLUSIVE FOUNDATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/05/2026
-----------------------------------------------------
Last Update Date | 06/05/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3034 TULARE ST
-----------------------------------------------------
City | FRESNO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93721-1415
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-918-3986
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3034 TULARE ST
-----------------------------------------------------
City | FRESNO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93721-1415
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-918-3986
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO
-----------------------------------------------------
Name | DR. JULIE NICOLE
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 802-309-1881
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QC1500X
-----------------------------------------------------
Taxonomy Name | Community Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------