MODESTO PRIMARY CARE NPI 1841215530

NPI Information

  • NPI: 1841215530
  • Provider Name: MODESTO PRIMARY CARE
  • Classification: Clinic/Center - 261QP2300X
  • Specialization: Primary Care
  • Entity Type: Organization
  • CLIA Number: 05D1026555
  • Address: 2020 COFFEE RD STE J2
    MODESTO, CA
    ZIP 95355
  • Phone: (209) 572-0191

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NPI Details

MODESTO PRIMARY CARE is a primary care clinic center in Modesto, CA. MODESTO PRIMARY CARE NPI is 1841215530. The provider is registered as an organization entity type.

The provider's business location address is:

2020 COFFEE RD STE J2
MODESTO, CA
ZIP 95355-416
Phone: (209) 572-0191

The provider's authorized official is Michelle Wattle .
The authorized official title is Office Manager and has the following contact phone number (209) 575-4575.

The CLIA number assigned to this NPI record is 05D1026555 - community clinic with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 7/13/2006 and was last updated on 8/6/2008.

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 Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1261QP2300XClinic/CenterPrimary CareA17110CALIFORNIAYes

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 Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1ZZZ18356ZMEDICARE ID-TYPE UNSPECIFIEDCALIFORNIA
2GR0086820MEDICAIDCALIFORNIA

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: 11/21/2025

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