Healthcare Provider Details

I. General information

NPI: 1437433893
Provider Name (Legal Business Name): PAULA GARDNER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2011
Last Update Date: 10/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 TULLY RD
MODESTO CA
95350-2946
US

IV. Provider business mailing address

1708 VINTAGE CIR
OAKDALE CA
95361-8662
US

V. Phone/Fax

Practice location:
  • Phone: 209-277-5695
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: