Organization
5 MEDICAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARIA DOLORES BUTLER (PRESIDENT)
(559) 353-2954
Entity
Organization
Contact information
Practice address
4656 E DAKOTA AVE, SUITE 103, FRESNO, CA 93726-4727
(559) 353-2954
(559) 353-2955
Mailing address
4656 E DAKOTA AVE, SUITE 103, FRESNO, CA 93726-4727
(559) 353-2954
(559) 353-2955
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0
PENDING MEDI-CAL
CA
01
—
0
PENDING
—
Enumeration date
01/27/2009
Last updated
05/12/2010
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