Provider Demographics
NPI:1588331185
Name:SRISUKWATANA, ALMA HUIZAR
Entity type:Individual
Prefix:
First Name:ALMA
Middle Name:HUIZAR
Last Name:SRISUKWATANA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2179 AIR FRESNO DRIVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93727
Mailing Address - Country:US
Mailing Address - Phone:559-600-8918
Mailing Address - Fax:559-600-7709
Practice Address - Street 1:2179 AIR FRESNO DRIVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93727
Practice Address - Country:US
Practice Address - Phone:559-600-8918
Practice Address - Fax:559-600-7709
Is Sole Proprietor?:No
Enumeration Date:2021-08-23
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA104350104100000X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker