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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