Organization
COUNTY OF STANISLAUS
Active
Other names
Stanislaus County Health Services Agency Specialty Clinics
Organization subpart
No
Provider details
NPI number
Authorized official
MARY ANN LEE (MANAGING DIRECTOR)
(209) 558-7163
Entity
Organization
Contact information
Practice address
830 SCENIC DR, SUITE B, MODESTO, CA 95350-6131
(209) 558-7000
Mailing address
830 SCENIC DR, SUITE B, MODESTO, CA 95350-6131
(209) 558-7000
(209) 558-5614
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CMM70759F
MEDICAL
CA
01
—
ZZZ21961Z
MEDICARE PTAN
CA
Enumeration date
06/25/2007
Last updated
03/09/2010
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