Healthcare Provider Details

I. General information

NPI: 1164768982
Provider Name (Legal Business Name): O & D SURGICAL AND MEDICAL SOLUTIONS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2012
Last Update Date: 12/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 EAST GRAGER AVENUE SUITE B
MODESTO CA
95350-4347
US

IV. Provider business mailing address

140 EAST GRAGER AVENUE SUITE B
MODESTO CA
95350-4347
US

V. Phone/Fax

Practice location:
  • Phone: 209-589-1500
  • Fax: 209-521-0813
Mailing address:
  • Phone: 209-589-1500
  • Fax: 209-521-0813

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License NumberA81970
License Number StateCA

VIII. Authorized Official

Name: JUAN JORGE DEL VALLE
Title or Position: C.E.O.
Credential: M.D.
Phone: 209-614-1445