Healthcare Provider Details

I. General information

NPI: 1619004561
Provider Name (Legal Business Name): MRS. GAYLE CASE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 KANSAS AVE STE B
MODESTO CA
95351-1596
US

IV. Provider business mailing address

1100 KANSAS AVE STE B
MODESTO CA
95351-1596
US

V. Phone/Fax

Practice location:
  • Phone: 209-848-6018
  • Fax: 209-848-6020
Mailing address:
  • Phone: 209-848-6018
  • Fax: 209-848-6020

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: