Healthcare Provider Details

I. General information

NPI: 1689066029
Provider Name (Legal Business Name): FAMILY FIRST MEDICAL CARE A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2015
Last Update Date: 08/26/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1317 OAKDALE RD STE 440
MODESTO CA
95355-3364
US

IV. Provider business mailing address

1317 OAKDALE RD SUITE 440
MODESTO CA
95355-3361
US

V. Phone/Fax

Practice location:
  • Phone: 209-522-3362
  • Fax: 209-522-3363
Mailing address:
  • Phone: 209-522-3362
  • Fax: 209-522-3363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number StateCA

VIII. Authorized Official

Name: SILVIA M DIEGO
Title or Position: PRINCIPLE OFFICER
Credential: M.D.
Phone: 209-522-3362