Healthcare Provider Details

I. General information

NPI: 1336228121
Provider Name (Legal Business Name): JOSEPH K FLUENCE MD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 12/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 COFFEE ROAD
MODESTO CA
95355
US

IV. Provider business mailing address

817 COFFEE ROAD C3
MODESTO CA
95355
US

V. Phone/Fax

Practice location:
  • Phone: 209-526-4500
  • Fax:
Mailing address:
  • Phone: 209-529-9603
  • Fax: 209-529-6610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberG42660
License Number StateCA

VIII. Authorized Official

Name: JOSEPH K FLUENCE
Title or Position: PRESIDENT
Credential: MD
Phone: 209-529-9603