Provider Demographics
NPI:1093898348
Name:COUNTY OF FRESNO
Entity Type:Organization
Organization Name:COUNTY OF FRESNO
Other - Org Name:DEPARTMENT OF PUBLIC HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:POMAVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, REHS
Authorized Official - Phone:559-600-3200
Mailing Address - Street 1:PO BOX 11800
Mailing Address - Street 2:6TH FLOOR
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93775-1800
Mailing Address - Country:US
Mailing Address - Phone:559-600-6415
Mailing Address - Fax:559-600-7692
Practice Address - Street 1:1221 FULTON MALL
Practice Address - Street 2:IMMUNIZATION CLINIC,1ST FLOOR
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93721-1915
Practice Address - Country:US
Practice Address - Phone:559-600-3281
Practice Address - Fax:559-600-7726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QP0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACF418AOtherMEDICARE
CA341OtherCHDP BLUE CROSS
CA351OtherCHDP HEALTH NET
CACH086OtherCHDP