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Organization
SUTTER GOULD MEDICAL FOUNDATION
Active
Organization
SUTTER GOULD MEDICAL FOUNDATION
Active
Other names
Fairmont Ave Care Center
Organization subpart
No
Provider details
NPI number
Authorized official
STEVEN A MITNICK MD (MEDICAL DIRECTOR)
(209) 521-6097
Entity
Organization
Contact information
Practice address
999 S FAIRMONT AVE, #130/135, LODI, CA 95240-5100
(209) 366-2001
Mailing address
600 COFFEE RD, MODESTO, CA 95355-4201
(209) 524-1211
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
Other
Enumeration date
05/27/2006
Last updated
05/06/2010
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