Healthcare Provider Details

I. General information

NPI: 1679213524
Provider Name (Legal Business Name): MR. AARON DAVID STRAIT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2022
Last Update Date: 03/30/2022
Certification Date: 03/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 5TH ST
MODESTO CA
95351-3316
US

IV. Provider business mailing address

605 5TH ST
MODESTO CA
95351-3316
US

V. Phone/Fax

Practice location:
  • Phone: 209-341-0718
  • Fax:
Mailing address:
  • Phone: 209-341-0718
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: