Healthcare Provider Details

I. General information

NPI: 1396941464
Provider Name (Legal Business Name): COUNTY OF STANISLAUS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2007
Last Update Date: 10/03/2024
Certification Date: 10/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 PARADISE RD SUITE E
MODESTO CA
95351-3104
US

IV. Provider business mailing address

401 PARADISE RD SUITE E
MODESTO CA
95351-3104
US

V. Phone/Fax

Practice location:
  • Phone: 209-558-4000
  • Fax: 209-558-8611
Mailing address:
  • Phone: 209-558-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARY ANN LEE
Title or Position: MANAGING DIRECTOR
Credential:
Phone: 209-558-7163