Provider Demographics
NPI:1316772262
Name:TIBURCIO, RAUL G
Entity type:Individual
Prefix:MR
First Name:RAUL
Middle Name:G
Last Name:TIBURCIO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3816 N PEARWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93727-0812
Mailing Address - Country:US
Mailing Address - Phone:559-493-9141
Mailing Address - Fax:
Practice Address - Street 1:6757 E CHRISTINE AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93727-1137
Practice Address - Country:US
Practice Address - Phone:559-209-7522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-02
Last Update Date:2024-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No376G00000XNursing Service Related ProvidersNursing Home Administrator