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General NPI Number Information
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NPI Number | 1215541628
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Entity Type | Organization
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Legal Business Name | PACIFIC CARE II
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Dates
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Enumeration Date | 09/02/2020
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Last Update Date | 09/02/2020
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Provider Practice Location Address
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Address Line | 1024 JAYHAWK WAY
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City | MODESTO
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State | CA
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Zip | 95358-6714
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Country | US
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Telephone | 209-523-0124
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Fax |
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Provider Business Mailing Address
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Address Line | 3708 BOLD RULER CT
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City | MODESTO
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State | CA
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Zip | 95355-8466
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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 | CEO
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Name | NAVNEET GILL
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Credential | MD
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Telephone | 209-523-0124
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State |
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