Healthcare Provider Details

I. General information

NPI: 1912285479
Provider Name (Legal Business Name): JOSHUA R MODLIN DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2011
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 W I ST
LOS BANOS CA
93635-3479
US

IV. Provider business mailing address

311 W I ST
LOS BANOS CA
93635-3479
US

V. Phone/Fax

Practice location:
  • Phone: 209-826-2222
  • Fax: 209-826-2599
Mailing address:
  • Phone: 209-826-2222
  • Fax: 209-826-2599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number073866
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPOD001062
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberE6269
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: