Individual
ANINA DEE BACON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2823 FRESNO ST, FRESNO, CA 93721-1324
(559) 443-2682
(559) 443-2681
Mailing address
2625 E DIVISADERO ST, FRESNO, CA 93721-1431
(559) 443-2682
(559) 443-2681
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
60979
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2034718
—
WA
Enumeration date
10/14/2013
Last updated
06/01/2022
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