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General NPI Number Information
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NPI Number | 1174877823
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Entity Type | Organization
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Legal Business Name | STANISLAUS COUNTY
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Dates
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Enumeration Date | 11/02/2012
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Last Update Date | 11/02/2012
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Provider Practice Location Address
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Address Line | 1208 9TH ST
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City | MODESTO
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State | CA
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Zip | 95354-0713
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Country | US
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Telephone | 209-558-4464
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Fax |
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Provider Business Mailing Address
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Address Line | 1010 10TH ST
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City | MODESTO
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State | CA
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Zip | 95354-0859
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | BHS II
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Name | MS. DAPHINE LAMB-PERRILLIAT
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Credential |
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Telephone | 209-558-4464
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number |
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License Number State |
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