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General NPI Number Information
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NPI Number | 1710333976
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Entity Type | Organization
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Legal Business Name | ELITE FIRST HEALTH
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Dates
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Enumeration Date | 05/06/2016
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Last Update Date | 05/21/2018
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Provider Practice Location Address
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Address Line | 3121 YOSEMITE BLVD STE D2
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City | MODESTO
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State | CA
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Zip | 95354
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Country | US
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Telephone | 206-566-9366
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 576810
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City | MODESTO
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State | CA
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Zip | 95357-6810
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Country | US
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Telephone | 209-484-0951
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Fax |
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Authorized Official
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Title or Position | FAMILY NURSE PRACTIONER
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Name | MRS. GIFTY AIDOO
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Credential | FNP-C
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Telephone | 209-484-0951
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 21215
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License Number State | CA
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