Individual
FADY BOULES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2002 N FINE AVE UNIT 101, FRESNO, CA 93727-1511
(951) 722-0801
Mailing address
18672 FLORIDA ST STE 201C, HUNTINGTON BEACH, CA 92648-6088
(951) 268-0745
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
95003306
CA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
95003306
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
D4304887
DRIVER LIC
CA
Enumeration date
10/23/2015
Last updated
03/01/2020
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