Healthcare Provider Details

I. General information

NPI: 1407159510
Provider Name (Legal Business Name): DAVID ANTHONY FALL FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2010
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1224 SCENIC DR
MODESTO CA
95350-6137
US

IV. Provider business mailing address

1224 SCENIC DR
MODESTO CA
95350-6137
US

V. Phone/Fax

Practice location:
  • Phone: 209-442-6077
  • Fax: 209-436-1310
Mailing address:
  • Phone: 209-442-6077
  • Fax: 209-436-1310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number20581
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: