Individual
DR. GHOLAMREZA VAFADOUSTE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2141 COLORADO AVE, TURLOCK, CA 95382-2011
(209) 575-4575
(209) 575-4598
Mailing address
PO BOX 4398, MODESTO, CA 95352-4398
(209) 575-4575
(209) 575-4598
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
A79905
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A799050
—
CA
Enumeration date
05/05/2006
Last updated
04/16/2010
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