Healthcare Provider Details

I. General information

NPI: 1104632249
Provider Name (Legal Business Name): CENTRAL CALIFORNIA BARIATRIC SURGERY, PARTNERSHIP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2024
Last Update Date: 05/07/2025
Certification Date: 05/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 SYLVAN AVE STE A
MODESTO CA
95350-1699
US

IV. Provider business mailing address

1552 COFFEE RD STE 200
MODESTO CA
95355-3122
US

V. Phone/Fax

Practice location:
  • Phone: 209-248-7168
  • Fax: 209-248-0995
Mailing address:
  • Phone: 209-248-7168
  • Fax: 209-248-0995

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. ANDREW T HUBER
Title or Position: MD/ PARTNER / CO OWNER
Credential: MD
Phone: 209-248-7168