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SUTTER GOULD MEDICAL FOUNDATION NPI 1558301713


NPI Information

NPI: 1558301713
Provider Name: SUTTER GOULD MEDICAL FOUNDATION

Doing Business As: COFFEE ROAD CARE CENTER

Classification: Pediatrics - 208000000X
Entity Type: Organization

CLIA Number: 05D2222610

Address:
1144 COFFEE RD
MODESTO, CA
ZIP 95355
Phone: (209) 550-4744
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SUTTER GOULD MEDICAL FOUNDATION is a pediatrics in Modesto, CA. The provider is a pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. SUTTER GOULD MEDICAL FOUNDATION NPI is 1558301713. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Coffee Road Care Center.

The provider's business location address is:

1144 COFFEE RD
MODESTO, CA
ZIP 95355-205
Phone: (209) 550-4744

The provider's authorized official is Steven A Mitnick .
The authorized official title is Medical Director and has the following contact phone number (209) 521-6097.

The CLIA number assigned to this NPI record is 05D2222610 - end stage renal disease dialysis facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 6/7/2006 and was last updated on 5/6/2010.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1208000000XPediatricsYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1ZZZ20685ZMEDICARE PINCALIFORNIA
20586060013MEDICARE NSCCALIFORNIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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