Healthcare Provider Details

I. General information

NPI: 1407843345
Provider Name (Legal Business Name): VALLEY OAK PEDIATRIC ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4120 PRESCOTT RD
MODESTO CA
95356-8418
US

IV. Provider business mailing address

4120 PRESCOTT RD
MODESTO CA
95356-8418
US

V. Phone/Fax

Practice location:
  • Phone: 209-544-7300
  • Fax: 209-544-7323
Mailing address:
  • Phone: 209-544-7300
  • Fax: 209-544-7323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SARAH L KOCH
Title or Position: PRESIDENT
Credential: MD
Phone: 209-544-7300