Healthcare Provider Details

I. General information

NPI: 1972448967
Provider Name (Legal Business Name): DAWN RONQUILLO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2026
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 SCENIC DR BLDG F
MODESTO CA
95350-6131
US

IV. Provider business mailing address

800 SCENIC DR BLDG F
MODESTO CA
95350-6131
US

V. Phone/Fax

Practice location:
  • Phone: 209-525-6150
  • Fax:
Mailing address:
  • Phone: 209-525-6150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: