Healthcare Provider Details

I. General information

NPI: 1295850048
Provider Name (Legal Business Name): SUSAN WAYS PHD MD INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 04/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W COOLIDGE AVE
MODESTO CA
95350-4447
US

IV. Provider business mailing address

200 W COOLIDGE AVE
MODESTO CA
95350-4447
US

V. Phone/Fax

Practice location:
  • Phone: 209-577-5005
  • Fax: 209-521-1533
Mailing address:
  • Phone: 209-577-5005
  • Fax: 209-521-1533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberG63946
License Number StateCA

VIII. Authorized Official

Name: SUSAN CYNTHIA WAYS
Title or Position: CEO
Credential: M.D.
Phone: 209-577-5005