Provider Demographics
NPI:1033291331
Name:FRESNO UNIFIED SCHOOL DISTRICT DEPT. OF HEALTH SERVICES
Entity Type:Organization
Organization Name:FRESNO UNIFIED SCHOOL DISTRICT DEPT. OF HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERIM DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:TORNA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:559-248-7387
Mailing Address - Street 1:3058 N MILLBROOK AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93703-1424
Mailing Address - Country:US
Mailing Address - Phone:559-248-7387
Mailing Address - Fax:559-248-7381
Practice Address - Street 1:3058 N MILLBROOK AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93703-1424
Practice Address - Country:US
Practice Address - Phone:559-248-7387
Practice Address - Fax:559-248-7381
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASS1062166251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASS1062166Medicaid