Healthcare Provider Details

I. General information

NPI: 1891304895
Provider Name (Legal Business Name): ARGIE GULAPA VILA FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2020
Last Update Date: 09/11/2024
Certification Date: 09/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 OAKDALE RD
MODESTO CA
95355-3357
US

IV. Provider business mailing address

101 BODIN CIR
TRAVIS AFB CA
94535-1809
US

V. Phone/Fax

Practice location:
  • Phone: 209-557-6200
  • Fax:
Mailing address:
  • Phone: 707-423-3247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95011316
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: