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General NPI Number Information
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NPI Number | 1366461782
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Entity Type | Organization
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Legal Business Name | MODERN NEUROCARE MEDICAL CENTER
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Dates
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Enumeration Date | 07/18/2006
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Last Update Date | 12/07/2018
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Provider Practice Location Address
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Address Line | 1801 E MARCH LN SUITE B-220
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City | STOCKTON
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State | CA
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Zip | 95210-6629
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Country | US
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Telephone | 209-951-8830
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Fax | 209-951-8831
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Provider Business Mailing Address
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Address Line | PO BOX 7393
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City | STOCKTON
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State | CA
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Zip | 95267-0393
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Country | US
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Telephone | 209-951-8830
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Fax | 209-951-8831
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | MADAN PRASAD
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Credential | MD
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Telephone | 209-951-8830
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | A86600
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License Number State | CA
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