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General NPI Number Information
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NPI Number | 1215440631
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Entity Type | Organization
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Legal Business Name | STANISLAUS HEALTH AND WELLNESS INC
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Dates
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Enumeration Date | 11/07/2017
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Last Update Date | 09/18/2023
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Provider Practice Location Address
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Address Line | 1908 COFFEE RD STE 3
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City | MODESTO
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State | CA
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Zip | 95355
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Country | US
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Telephone | 209-846-9429
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Fax | 209-551-1665
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Provider Business Mailing Address
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Address Line | PO BOX 578700
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City | MODESTO
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State | CA
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Zip | 95357-8700
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Country | US
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Telephone | 209-551-0420
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Fax | 209-551-1665
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GEORGE I JACOB
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Credential |
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Telephone | 209-846-9429
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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