Individual
MR. MAHESH G MODI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2160 W GRANT LINE RD, SUITE 240, TRACY, CA 95377-7330
(209) 833-6118
(209) 835-7999
Mailing address
PO BOX 986, WOODBRIDGE, CA 95258-0986
(209) 339-9036
(209) 339-1901
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
A37333
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A373330
—
CA
Enumeration date
01/27/2006
Last updated
01/20/2010
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