Basic Information
| Provider Information | |||||||||
| NPI: | 1881746717 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FRESNO COUNTY NORTH FRESNO REGIONAL MH CLINIC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 28 E MINARETS AVE | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | PINEDALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 936501215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5594360482 | ||||||||
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| Practice Location | |||||||||
| Address1: | 28 E MINARETS AVE | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | PINEDALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 936501215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5594360482 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | NGUYEN | ||||||||
| AuthorizedOfficialFirstName: | GIANG | ||||||||
| AuthorizedOfficialMiddleName: | T | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR, FRESNO CO MENTAL HEALTH | ||||||||
| AuthorizedOfficialTelephone: | 5592539180 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0801X | CA | Y | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
ID Information
| ID | Type | State | Issuer | Description | 2355 | 01 | CA | COST CENTER | OTHER |