Healthcare Provider Details

I. General information

NPI: 1033069653
Provider Name (Legal Business Name): DIEGO SURGICAL INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2026
Last Update Date: 02/02/2026
Certification Date: 02/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1317 OAKDALE RD STE 420
MODESTO CA
95355-3364
US

IV. Provider business mailing address

1317 OAKDALE RD STE 420
MODESTO CA
95355-3364
US

V. Phone/Fax

Practice location:
  • Phone: 209-522-3362
  • Fax: 209-497-6303
Mailing address:
  • Phone: 209-522-3362
  • Fax: 209-497-6303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSE L DIEGO
Title or Position: GENERAL SURGEON
Credential: MD
Phone: 209-522-3362