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Organization
SUTTER GOULD MEDICAL FOUNDATION
Active
Organization
SUTTER GOULD MEDICAL FOUNDATION
Active
Other names
Coffee Road 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
1144 COFFEE RD, MODESTO, CA 95355-4205
(209) 550-4744
Mailing address
600 COFFEE RD, MODESTO, CA 95355-4201
(209) 524-1211
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Enumeration date
06/07/2006
Last updated
05/06/2010
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