Healthcare Provider Details

I. General information

NPI: 1164754347
Provider Name (Legal Business Name): FAMILY PRACTICE HEALTH AND WELLNESS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2010
Last Update Date: 03/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 STANDIFORD AVE BLD D SUITE D1
MODESTO CA
95350-6529
US

IV. Provider business mailing address

2980 N BEVERLY GLEN CIR STE 100
LOS ANGELES CA
90077-1728
US

V. Phone/Fax

Practice location:
  • Phone: 209-575-4990
  • Fax:
Mailing address:
  • Phone: 310-474-9809
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: DR. KATHY CHRISTOPHER
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 209-575-4990