Organization
GREATER FRESNO HEALTH ORGNIZATION, INC.
Active
Organization
GREATER FRESNO HEALTH ORGNIZATION, INC.
Active
Other names
KINGS WINERY MEDICLA CLINIC
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BLA MOUANOUTOUA (CEO)
(559) 255-6476
Entity
Organization
Contact information
Practice address
4929 E KINGS CANYON RD, FRESNO, CA 93727-3812
(559) 255-6476
(559) 255-7906
Mailing address
4929 E KINGS CANYON RD, FRESNO, CA 93727-3812
(559) 255-6476
(559) 255-7906
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
040000336
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
EAP70517F
—
CA
Enumeration date
10/07/2009
Last updated
04/29/2024
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