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General NPI Number Information
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NPI Number | 1932610847
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Entity Type | Organization
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Legal Business Name | MODESTO MENTAL HEALTH CONSULTANTS INC A PROFESSIONAL MEDICAL CORP
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Dates
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Enumeration Date | 10/18/2017
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Last Update Date | 02/25/2019
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Provider Practice Location Address
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Address Line | 1501 CLAUS RD
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City | MODESTO
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State | CA
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Zip | 95355
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Country | US
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Telephone | 209-558-4700
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Fax |
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Provider Business Mailing Address
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Address Line | 220 STANDIFORD AVE STE F
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City | MODESTO
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State | CA
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Zip | 95350-1159
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Country | US
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Telephone | 209-579-5628
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ANTOUN MANGANAS
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Credential | MD
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Telephone | 209-604-6521
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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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