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General NPI Number Information
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NPI Number | 1710009022
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Entity Type | Organization
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Legal Business Name | MODESTO ON-CALL SERVICES, LLC
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Dates
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Enumeration Date | 04/06/2007
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Last Update Date | 06/08/2016
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Provider Practice Location Address
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Address Line | 1441 FLORIDA AVE
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City | MODESTO
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State | CA
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Zip | 95350-4405
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Country | US
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Telephone | 209-342-3124
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Fax | 209-342-3123
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Provider Business Mailing Address
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Address Line | 1441 FLORIDA AVE
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City | MODESTO
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State | CA
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Zip | 95350-4405
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Country | US
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Telephone | 209-342-3124
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Fax | 209-342-3123
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Authorized Official
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Title or Position | REGIONAL CMO; TENET
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Name | DR. RONALD KAUFMAN
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Credential |
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Telephone | 714-428-6812
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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 |
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License Number State |
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