Healthcare Provider Details

I. General information

NPI: 1174877823
Provider Name (Legal Business Name): STANISLAUS COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2012
Last Update Date: 11/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1208 9TH ST
MODESTO CA
95354-0713
US

IV. Provider business mailing address

1010 10TH ST
MODESTO CA
95354-0859
US

V. Phone/Fax

Practice location:
  • Phone: 209-558-4464
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: MS. DAPHINE LAMB-PERRILLIAT
Title or Position: BHS II
Credential:
Phone: 209-558-4464