Healthcare Provider Details

I. General information

NPI: 1588646004
Provider Name (Legal Business Name): ANURADHA DUBEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 03/07/2023
Certification Date: 03/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4312 SPYRES WAY
MODESTO CA
95356-9259
US

IV. Provider business mailing address

4312 SPYRES WAY
MODESTO CA
95356-9259
US

V. Phone/Fax

Practice location:
  • Phone: 209-497-6767
  • Fax: 209-497-6565
Mailing address:
  • Phone: 209-497-6767
  • Fax: 209-497-6565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA87166
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: