Organization
BODY AND MIND HEALTHCARE SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARCEL FOMOTAR NP (OWNER)
(408) 449-6623
Entity
Organization
Contact information
Practice address
1085 SANDERS AVE, CLOVIS, CA 93619-3935
(408) 449-6623
(320) 238-7625
Mailing address
1085 SANDERS AVE, CLOVIS, CA 93619-3935
(408) 449-6623
(320) 238-7625
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
09/15/2022
Last updated
09/15/2022
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