Healthcare Provider Details

I. General information

NPI: 1154732477
Provider Name (Legal Business Name): USP ATWATER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2014
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 FEDERAL WAY
ATWATER CA
95301-5174
US

IV. Provider business mailing address

1 FEDERAL WAY
ATWATER CA
95301-5174
US

V. Phone/Fax

Practice location:
  • Phone: 209-386-4791
  • Fax:
Mailing address:
  • Phone: 209-386-4791
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number StateCA

VIII. Authorized Official

Name: MRS. LOURDES METTRY
Title or Position: HEALTH SERVICE ADMINISTRATOR
Credential: R.N.
Phone: 209-386-4791