MEDICARE: MRS. TIEN THUY MONDIENTZ FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	95035265	CA

General Provider Information

NPI Number	:	1366335390
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TIEN THUY MONDIENTZ FNP-C

Provider Business Mailing Address
First Line	:	3865 VALOR AVE
Second Line	:
City	:	CLOVIS
State	:	CA
Zip	:	93619-7967
Country	:	US
Telephone Number	:	559-776-9684
Fax Number	:

Provider Business Practice Location Address
First Line	:	7210 N MILBURN AVE STE 105
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93722-8449
Country	:	US
Telephone Number	:	559-224-5003
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/29/2025
Last Update Date	:	06/04/2025

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