Facts
- Status
- A
- Credential
- MFT
- Type
- Individual
- Enumeration date
- 2007-03-14
- Last updated
- 2007-07-08
Specialties
Licenses
- License CA
- MFC 37507
Location
- Practice location
- 251 E HACKETT RD
- City
- MODESTO CA
- Postal code
- 953589415
- Phone
- 209-558-2421
Medicare
- PECOS
- No PECOS enrollment row matched this NPI.
LEIE
The OIG NPI list is not in this build yet. Confirm on OIG's search.
Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.