Healthcare Provider Details

I. General information

NPI: 1891986584
Provider Name (Legal Business Name): SEMEON S SPIRIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2007
Last Update Date: 05/16/2025
Certification Date: 05/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 CLAUS RD 201
MODESTO CA
95355-9711
US

IV. Provider business mailing address

220 STANDIFORD AVE F
MODESTO CA
95350-1159
US

V. Phone/Fax

Practice location:
  • Phone: 209-557-6310
  • Fax: 209-557-6388
Mailing address:
  • Phone: 209-579-5628
  • Fax: 209-579-5637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number125053807
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA136650
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: