Healthcare Provider Details

I. General information

NPI: 1508675729
Provider Name (Legal Business Name): GBC MODESTO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2025
Last Update Date: 01/02/2025
Certification Date: 01/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 SISK RD
MODESTO CA
95356-0535
US

IV. Provider business mailing address

5841 N WALNUT RD
TURLOCK CA
95382-9528
US

V. Phone/Fax

Practice location:
  • Phone: 877-828-8476
  • Fax: 877-252-3970
Mailing address:
  • Phone: 209-604-5969
  • Fax: 877-252-3970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: LINDA YOUSEF
Title or Position: COO
Credential:
Phone: 877-828-8476