Healthcare Provider Details

I. General information

NPI: 1255183513
Provider Name (Legal Business Name): VICK ALBERT GUINARD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2024
Last Update Date: 04/02/2024
Certification Date: 04/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1130 12TH ST STE B
MODESTO CA
95354-0834
US

IV. Provider business mailing address

1130 12TH ST STE B
MODESTO CA
95354-0834
US

V. Phone/Fax

Practice location:
  • Phone: 209-525-6043
  • Fax:
Mailing address:
  • Phone: 209-525-6043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: