Healthcare Provider Details

I. General information

NPI: 1861564866
Provider Name (Legal Business Name): GARY J PADOVANI MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1421 OAKDALE ROAD
MODESTO CA
95355
US

IV. Provider business mailing address

817 COFFEE ROAD C3
MODESTO CA
95355
US

V. Phone/Fax

Practice location:
  • Phone: 209-572-2700
  • 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 NumberG44340
License Number StateCA

VIII. Authorized Official

Name: GARY J PADOVANI
Title or Position: PRESIDENT
Credential: MD
Phone: 209-529-9603