=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639406010
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | O & D MEDICAL SOLUTIONS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/05/2009
-----------------------------------------------------
Last Update Date | 11/05/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1441 FLORIDA AVE
-----------------------------------------------------
City | MODESTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95350-4405
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-471-8330
-----------------------------------------------------
Fax | 209-491-7184
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 2307
-----------------------------------------------------
City | OAKDALE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95361-5307
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-571-8330
-----------------------------------------------------
Fax | 209-491-7184
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CO OWNER
-----------------------------------------------------
Name | MARIA OBISPO
-----------------------------------------------------
Credential | N.P.
-----------------------------------------------------
Telephone | 209-743-0546
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 451612
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | A81970
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------