Healthcare Provider Details

I. General information

NPI: 1245097872
Provider Name (Legal Business Name): MATTHEW JAMES LAMBERT FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/29/2024
Last Update Date: 03/09/2024
Certification Date: 03/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 COFFEE RD
MODESTO CA
95355-2803
US

IV. Provider business mailing address

1700 COFFEE RD
MODESTO CA
95355-2803
US

V. Phone/Fax

Practice location:
  • Phone: 209-569-7600
  • Fax:
Mailing address:
  • Phone: 209-569-7600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number95028831
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95028831
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: