Healthcare Provider Details

I. General information

NPI: 1457270258
Provider Name (Legal Business Name): JOSE MARTIN AGUAYO RAMOS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 LAS VEGAS ST
MODESTO CA
95358-5500
US

IV. Provider business mailing address

1700 LAUREL AVE
MERCED CA
95341-5149
US

V. Phone/Fax

Practice location:
  • Phone: 209-384-6486
  • Fax: 209-359-2045
Mailing address:
  • Phone: 619-771-5018
  • Fax: 209-359-2045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number210010
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: