1891785143 NPI number — R. FELLEN, INC.

Table of content: (NPI 1891785143)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891785143 NPI number — R. FELLEN, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
R. FELLEN, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1891785143
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/23/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2939 S PEACH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRESNO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93725-9302
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
559-233-6248
Provider Business Mailing Address Fax Number:
559-233-3368

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2939 S PEACH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRESNO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93725-9302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-233-6248
Provider Business Practice Location Address Fax Number:
559-233-3368
Provider Enumeration Date:
10/27/2005

Additional Information

Authorized Official

Authorized Official Last Name:
FELLEN
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
559-233-6248

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  040000154 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: ZZR18427F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com