Organization
COUNTY OF STANISLAUS
Active
Other names
Stanislaus County Health Services Agency Paradise Medical Office
Organization subpart
No
Provider details
NPI number
Authorized official
MARY ANN LEE (MANAGING DIRECTOR)
(209) 558-7163
Entity
Organization
Contact information
Practice address
401 PARADISE RD, SUITE E, MODESTO, CA 95351-3104
(209) 558-4000
(209) 558-8611
Mailing address
401 PARADISE RD, SUITE E, MODESTO, CA 95351-3104
(209) 558-4000
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
EXE70074F
MEDICAL
CA
01
—
FHC70074F
MEDICAL
—
01
—
HAP70074F
FAMILY PACT
CA
Enumeration date
06/25/2007
Last updated
10/03/2024
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