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Organization
MODESTO NEONATAL MEDICAL GROUP, INC.
Active
Organization
MODESTO NEONATAL MEDICAL GROUP, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. GINA WALLACE (BILLING AGENT)
(209) 571-8330
Entity
Organization
Contact information
Practice address
1441 FLORIDA AVE, MODESTO, CA 95350-4405
(209) 571-8330
Mailing address
PO BOX 577558, MODESTO, CA 95357-7558
(209) 571-8330
(209) 491-7184
Taxonomy
Speciality
Code
Description
License number
State
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
39491
CA
Other
Enumeration date
08/01/2007
Last updated
08/01/2007
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