Organization
STANISLAUS COUNTY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DAPHINE LAMB-PERRILLIAT (BHS II)
(209) 558-4464
Entity
Organization
Contact information
Practice address
1208 9TH ST, MODESTO, CA 95354-0713
(209) 558-4464
Mailing address
1010 10TH ST, MODESTO, CA 95354-0859
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
—
—
Other
Enumeration date
11/02/2012
Last updated
11/02/2012
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