Provider Demographics
NPI:1346731106
Name:VEN, VISNA
Entity Type:Individual
Prefix:
First Name:VISNA
Middle Name:
Last Name:VEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4326 E FAIRFAX AVE APT 101
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93703-3479
Mailing Address - Country:US
Mailing Address - Phone:559-709-7758
Mailing Address - Fax:
Practice Address - Street 1:4326 E FAIRFAX AVE APT 101
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93703-3479
Practice Address - Country:US
Practice Address - Phone:559-709-7758
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-28
Last Update Date:2018-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst