Healthcare Provider Details

I. General information

NPI: 1114342805
Provider Name (Legal Business Name): FIEL DONQUILA GAMAD FNP-C, PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2014
Last Update Date: 05/02/2024
Certification Date: 12/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1130 COFFEE RD STE 10
MODESTO CA
95355-4228
US

IV. Provider business mailing address

3916 LAKESIDE DR
MODESTO CA
95355-7312
US

V. Phone/Fax

Practice location:
  • Phone: 559-624-6090
  • Fax:
Mailing address:
  • Phone: 559-495-8659
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN 676426
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95000474
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95000474
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: