MODESTO PRIMARY CARE NPI 1841215530

NPI Information

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:

Other Identifiers

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

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