Healthcare Provider Details

I. General information

NPI: 1043663081
Provider Name (Legal Business Name): JESSICA LANTO HS DIPLOMA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2016
Last Update Date: 02/05/2020
Certification Date: 02/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2630 W RUMBLE RD
MODESTO CA
95350-0155
US

IV. Provider business mailing address

PO BOX 685
HUGHSON CA
95326-0685
US

V. Phone/Fax

Practice location:
  • Phone: 209-579-9444
  • Fax: 209-579-9494
Mailing address:
  • Phone:
  • Fax: 209-579-9494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: