Organization
MODESTO KIDNEY CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JERRY GREEN (SECRETARY)
(562) 495-8075
Entity
Organization
Contact information
Practice address
305 E GRANGER AVE, MODESTO, CA 95350-4345
(209) 574-6800
(209) 574-6808
Mailing address
1 WORLD TRADE CTR, 2500, LONG BEACH, CA 90831-0002
(562) 495-8075
(562) 495-8076
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
CDC02783F
—
CA
Enumeration date
01/30/2006
Last updated
08/22/2020
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