Healthcare Provider Details

I. General information

NPI: 1215440631
Provider Name (Legal Business Name): STANISLAUS HEALTH AND WELLNESS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2017
Last Update Date: 09/18/2023
Certification Date: 09/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1908 COFFEE RD STE 3
MODESTO CA
95355
US

IV. Provider business mailing address

PO BOX 578700
MODESTO CA
95357-8700
US

V. Phone/Fax

Practice location:
  • Phone: 209-846-9429
  • Fax: 209-551-1665
Mailing address:
  • Phone: 209-551-0420
  • Fax: 209-551-1665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. GEORGE I JACOB
Title or Position: PRESIDENT
Credential:
Phone: 209-846-9429