Healthcare Provider Details

I. General information

NPI: 1184870222
Provider Name (Legal Business Name): JANET GANJEH RNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JANET GANJEH

II. Dates (important events)

Enumeration Date: 08/08/2008
Last Update Date: 08/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 COFFEE RD
MODESTO CA
95355
US

IV. Provider business mailing address

2717 SAGEMILL DR.
MODESTO CA
95355-8615
US

V. Phone/Fax

Practice location:
  • Phone: 209-526-4500
  • Fax: 209-551-3170
Mailing address:
  • Phone: 209-551-3170
  • Fax: 209-551-3170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN352732
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: