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General NPI Number Information
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NPI Number | 1619576576
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Entity Type | Individual
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Provider Name | THETHONG P THEPVONG EMT
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Gender | Male
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Dates
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Enumeration Date | 10/21/2020
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Last Update Date | 10/21/2020
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Provider Practice Location Address
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Address Line | 900 W BELGRAVIA AVE
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City | FRESNO
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State | CA
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Zip | 93706-3909
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Country | US
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Telephone | 559-265-2045
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Fax |
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Provider Business Mailing Address
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Address Line | 1115 E GOSHEN AVE
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City | FRESNO
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State | CA
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Zip | 93720-2621
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Country | US
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Telephone | 559-259-0994
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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 | 207PE0004X
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Taxonomy Name | Emergency Medical Services (Emergency Medicine) Physician
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License Number | E119251
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License Number State | CA
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