Healthcare Provider Details

I. General information

NPI: 1023283504
Provider Name (Legal Business Name): SEIRRA HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2008
Last Update Date: 04/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 TULLY RD SUIT F
MODESTO CA
95350-2931
US

IV. Provider business mailing address

1801 TULLY RD STE F
MODESTO CA
95350-2931
US

V. Phone/Fax

Practice location:
  • Phone: 209-526-5770
  • Fax: 209-544-1234
Mailing address:
  • Phone: 209-526-5770
  • Fax: 209-544-1234

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA12831
License Number StateCA

VIII. Authorized Official

Name: MRS. ANEETA D KUMAR
Title or Position: OFFICE MANAGER
Credential:
Phone: 209-526-5770