Healthcare Provider Details

I. General information

NPI: 1982678587
Provider Name (Legal Business Name): SUTTER CENTRAL VALLEY HOSPITALS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 04/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 COFFEE RD
MODESTO CA
95355-2803
US

IV. Provider business mailing address

1800 COFFEE RD SUITE 87
MODESTO CA
95355-2705
US

V. Phone/Fax

Practice location:
  • Phone: 209-569-7172
  • Fax: 209-569-7634
Mailing address:
  • Phone: 209-569-7532
  • Fax: 209-569-7634

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number
License Number StateCA

VIII. Authorized Official

Name: MR. STAN BRYDA
Title or Position: DIRECTOR
Credential:
Phone: 209-572-7172