Healthcare Provider Details

I. General information

NPI: 1508203951
Provider Name (Legal Business Name): ELIZABETH PURTO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2013
Last Update Date: 01/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1208 9TH ST
MODESTO CA
95354-0713
US

IV. Provider business mailing address

2101 GEER RD STE 120
TURLOCK CA
95382-2456
US

V. Phone/Fax

Practice location:
  • Phone: 209-558-4464
  • Fax:
Mailing address:
  • Phone: 209-664-8044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: