Provider Demographics
NPI:1528192333
Name:FRESNO COUNTY FEE FOR SERVICE MIXED SPECIALTY GROUP
Entity Type:Organization
Organization Name:FRESNO COUNTY FEE FOR SERVICE MIXED SPECIALTY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, FRESNO CO MENTAL HEALTH
Authorized Official - Prefix:
Authorized Official - First Name:GIANG
Authorized Official - Middle Name:T
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-253-9180
Mailing Address - Street 1:4441 E KINGS CANYON RD
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93702-3604
Mailing Address - Country:US
Mailing Address - Phone:559-253-9180
Mailing Address - Fax:
Practice Address - Street 1:4409 E INYO ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93702-2977
Practice Address - Country:US
Practice Address - Phone:559-453-3806
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
2682OtherCOST CENTER