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General NPI Number Information
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NPI Number | 1861626616
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Entity Type | Organization
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Legal Business Name | STANISLAUS FAMILY MEDICINE RESIDENCY
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Dates
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Enumeration Date | 05/07/2009
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Last Update Date | 05/07/2009
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Provider Practice Location Address
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Address Line | 401 PARADISE RD STE E
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City | MODESTO
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State | CA
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Zip | 95351-3163
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Country | US
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Telephone | 209-558-4000
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Fax |
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Provider Business Mailing Address
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Address Line | 1934 CHELSEA AVE
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City | MODESTO
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State | CA
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Zip | 95350-2810
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | REDIDENT PHYSICIAN
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Name | DR. HOSSEIN HASSANI
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Credential |
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Telephone | 707-416-1796
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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