Organization
COUNTY OF FRESNO
Active
Other names
Department of Public Health
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID POMAVILLE M.B.A., R.E.H.S. (DIRECTOR)
(559) 600-3200
Entity
Organization
Contact information
Practice address
1221 FULTON MALL, IMMUNIZATION CLINIC,1ST FLOOR, FRESNO, CA 93721-1915
(559) 600-3281
(559) 600-7726
Mailing address
PO BOX 11800, 6TH FLOOR, FRESNO, CA 93775-1800
(559) 600-6415
(559) 600-7692
Taxonomy
Speciality
Code
Description
License number
State
261QP0905X
State or Local Public Health Clinic/Center
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
341
CHDP BLUE CROSS
CA
01
—
351
CHDP HEALTH NET
CA
01
—
CF418A
MEDICARE
CA
01
—
CH086
CHDP
CA
Enumeration date
10/23/2006
Last updated
10/27/2014
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