Provider Demographics
NPI:1396991386
Name:HEALY, GARY MICHAEL
Entity type:Individual
Prefix:MR
First Name:GARY
Middle Name:MICHAEL
Last Name:HEALY
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 1:760 W NIELSEN AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93706-1731
Mailing Address - Country:US
Mailing Address - Phone:559-268-0139
Mailing Address - Fax:559-268-0211
Practice Address - Street 1:760 W NIELSEN AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93706-1731
Practice Address - Country:US
Practice Address - Phone:559-268-0139
Practice Address - Fax:559-268-0211
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-11
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator