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General NPI Number Information
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NPI Number | 1760779797
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Entity Type | Organization
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Legal Business Name | 1589 WEST SHAW AVE
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Dates
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Enumeration Date | 06/28/2011
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1589 W SHAW AVE SUITE # 7
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City | FRESNO
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State | CA
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Zip | 93711-3500
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Country | US
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Telephone | 559-222-6300
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Fax | 559-222-6301
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Provider Business Mailing Address
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Address Line | 8936 E HERNDON AVE
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City | CLOVIS
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State | CA
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Zip | 93619-9088
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Country | US
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Telephone | 559-222-6300
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MISS ESIOHE JENNIFER IDONI
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Credential | AS
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Telephone | 559-222-6300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State | CA
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