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NPI Code Detail

MEDICARE: CHIA THAO LVN 697698

MEDICARE: CHIA THAO LVN 697698
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
1164X00000XLicensed Vocational Nurse697698CA

General Provider Information

NPI Number : 1962121814
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHIA THAO LVN 697698
Provider Business Mailing Address
First Line : 565 GREENFIELD AVE
Second Line :
City : CLOVIS
State : CA
Zip : 93611-6871
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 258 N BLACKSTONE AVE
Second Line :
City : FRESNO
State : CA
Zip : 93701-1913
Country : US
Telephone Number : 559-274-0299
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/24/2022
Last Update Date : 08/24/2022

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Directions to “ CHIA THAO LVN 697698” Practice Location

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