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Organization
MODESTO PEDIATRICS
Active
Organization
MODESTO PEDIATRICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANN MARIE TRUSCELLO MD (PRESIDENT)
(209) 522-0001
Entity
Organization
Contact information
Practice address
3109 COFFEE RD, STE A, MODESTO, CA 95355-1766
(209) 522-0001
(209) 549-7077
Mailing address
PO BOX 578202, MODESTO, CA 95357-8202
(209) 522-0001
(209) 549-7077
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
G68634
CA
208000000X
Pediatrics Physician
G83542
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0094690
—
CA
01
—
ZZZ07358Z
BLUE SHIELD GROUP PIN
CA
Enumeration date
09/13/2006
Last updated
08/16/2011
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