Provider Demographics
NPI:1225682701
Name:NEGRETE, MARIAH ISABEL
Entity Type:Individual
Prefix:
First Name:MARIAH
Middle Name:ISABEL
Last Name:NEGRETE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5503 W PINEDALE AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93722-2348
Mailing Address - Country:US
Mailing Address - Phone:559-930-5821
Mailing Address - Fax:
Practice Address - Street 1:5503 W PINEDALE AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93722-2348
Practice Address - Country:US
Practice Address - Phone:559-930-5821
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-01
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program