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General NPI Number Information
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NPI Number | 1265537989
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Entity Type | Organization
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Legal Business Name | MODERN THERAPIES FOR MIND AND SOUL, INC
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Dates
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Enumeration Date | 09/14/2006
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Last Update Date | 01/16/2019
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Provider Practice Location Address
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Address Line | 552 W EATON AVE
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City | TRACY
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State | CA
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Zip | 95376-3422
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Country | US
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Telephone | 209-835-4043
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Fax | 209-835-4236
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Provider Business Mailing Address
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Address Line | 552 W EATON AVE
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City | TRACY
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State | CA
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Zip | 95376-3422
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Country | US
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Telephone | 209-835-4043
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Fax | 209-835-4236
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. HALA SALEEM
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Credential | M.D.
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Telephone | 209-835-4043
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | A677200
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License Number State | CA
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