Healthcare Provider Details

I. General information

NPI: 1639406010
Provider Name (Legal Business Name): O & D MEDICAL SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2009
Last Update Date: 11/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 FLORIDA AVE
MODESTO CA
95350-4405
US

IV. Provider business mailing address

PO BOX 2307
OAKDALE CA
95361-5307
US

V. Phone/Fax

Practice location:
  • Phone: 209-471-8330
  • Fax: 209-491-7184
Mailing address:
  • Phone: 209-571-8330
  • Fax: 209-491-7184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number451612
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA81970
License Number StateCA

VIII. Authorized Official

Name: MARIA OBISPO
Title or Position: CO OWNER
Credential: N.P.
Phone: 209-743-0546