Facts
- Status
- A
- Type
- Individual
- Enumeration date
- 2008-10-02
- Last updated
- 2008-10-02
Licenses
- License CA
- 070207
Location
- Practice location
- 1409 E BRIGGSMORE AVE
- City
- MODESTO CA
- Postal code
- 953552707
- Phone
- 209-524-1211
Medicare
- PECOS
- No PECOS enrollment row matched this NPI.
LEIE
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Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.