Healthcare Provider Details

I. General information

NPI: 1720432438
Provider Name (Legal Business Name): ANURADHA DUBEY, M.D., INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2016
Last Update Date: 03/04/2020
Certification Date: 03/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4312 SPYRES WAY
MODESTO CA
95356
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 Number
License Number State

VIII. Authorized Official

Name: DR. ANURADHA DUBEY
Title or Position: CEO
Credential: M.D.
Phone: 209-497-6767