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Organization
SCENIC FACULTY MEDICAL GROUP, INC.
Active
Organization
SCENIC FACULTY MEDICAL GROUP, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LINDA SIMPSON DELEGATED OFFICIAL (CREDENTIALING MANAGER)
(209) 567-2361
Entity
Organization
Contact information
Practice address
1031 15TH ST STE 6, MODESTO, CA 95354-1131
(209) 567-2361
Mailing address
1031 15TH ST STE 6, MODESTO, CA 95354-1131
(209) 567-2361
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0084460
—
CA
05
—
GR0084461
—
CA
05
—
GR0084462
—
CA
05
—
GR0084463
—
CA
05
—
GR0084464
—
CA
05
—
GR0084465
—
CA
05
—
GR0084466
—
CA
Enumeration date
07/14/2006
Last updated
08/28/2024
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