Healthcare Provider Details

I. General information

NPI: 1730053976
Provider Name (Legal Business Name): ANASTASIA LEGATOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2025
Last Update Date: 10/01/2025
Certification Date: 10/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 CORSON AVE
MODESTO CA
95350-5408
US

IV. Provider business mailing address

416 CORSON AVE
MODESTO CA
95350-5408
US

V. Phone/Fax

Practice location:
  • Phone: 209-521-1805
  • Fax: 209-521-1827
Mailing address:
  • Phone: 209-521-1805
  • Fax: 209-521-1827

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: