| Modesto Primary Care | |
|
2020 Coffee Rd Ste J2 Modesto CA 95355-2416 | |
| (209) 572-0191 | |
| Not Available |
| Full Name | Modesto Primary Care |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 2020 Coffee Rd Ste J2, Modesto, California |
| Authorized Official Name and Position | Michelle Wattle (OFFICE MANAGER) |
| Authorized Official Contact | 2095754575 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Modesto Primary Care Po Box 4398 Modesto CA 95352-4398 Ph: (209) 575-4575 | Modesto Primary Care 2020 Coffee Rd Ste J2 Modesto CA 95355-2416 Ph: (209) 572-0191 |
| NPI Number | 1841215530 |
|---|---|
| Provider Enumeration Date | 07/13/2006 |
| Last Update Date | 08/06/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841215530 | NPI | - | NPPES |
| GR0086820 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | A17110 (California) | Primary |
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