Healthcare Provider Details

I. General information

NPI: 1992017495
Provider Name (Legal Business Name): MS. MARY PAUL SILVA SR.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2010
Last Update Date: 07/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 SCENIC DR
MODESTO CA
95350-6131
US

IV. Provider business mailing address

505 S ACACIA AVE
RIPON CA
95366-2629
US

V. Phone/Fax

Practice location:
  • Phone: 209-277-5325
  • Fax: 209-525-6253
Mailing address:
  • Phone: 209-277-5325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: