Healthcare Provider Details

I. General information

NPI: 1679555213
Provider Name (Legal Business Name): ANTONIO E. APELLANES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 11/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 TENAYA DR
MODESTO CA
95354-3930
US

IV. Provider business mailing address

737 W CHILDS AVE
MERCED CA
95341-6805
US

V. Phone/Fax

Practice location:
  • Phone: 209-576-6766
  • Fax: 209-576-6770
Mailing address:
  • Phone: 209-385-5481
  • Fax: 209-383-1296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA61655
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: