| Premium Mental Health Services | |
|
1130 Coffee Rd Ste 10 Modesto CA 95355-4228 | |
| (209) 522-9054 | |
| (209) 522-2631 |
| Full Name | Premium Mental Health Services |
|---|---|
| Speciality | Family Medicine |
| Location | 1130 Coffee Rd Ste 10, Modesto, California |
| Authorized Official Name and Position | Mariela Gutierrez (CLINIC SUPERVISOR) |
| Authorized Official Contact | 2095229054 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Premium Mental Health Services 1130 Coffee Rd Ste 10 Modesto CA 95355-4228 Ph: (209) 522-9054 | Premium Mental Health Services 1130 Coffee Rd Ste 10 Modesto CA 95355-4228 Ph: (209) 522-9054 |
| NPI Number | 1467533737 |
|---|---|
| Provider Enumeration Date | 10/17/2006 |
| Last Update Date | 08/13/2024 |
| Medicare PECOS PAC ID | 4183615248 |
|---|---|
| Medicare Enrollment ID | O20040519000541 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467533737 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Secondary |
| Provider Name | Matthew Freitas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871535252 PECOS PAC ID: 8426037029 Enrollment ID: I20040716000960 |
| Provider Name | Kent A Hufford |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1487659272 PECOS PAC ID: 3577608579 Enrollment ID: I20100302000517 |
| Provider Name | Fiel D Gamad |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114342805 PECOS PAC ID: 7012130396 Enrollment ID: I20140514002260 |
| Provider Name | Maricelle Gamad |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619344348 PECOS PAC ID: 6103116371 Enrollment ID: I20160531000784 |
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