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Organization

ASPEN FAMILY MEDICAL GROUP OF MODESTO, INC.

Active
Other names
Premium Mental Health Services
Organization subpart
No

Provider details

NPI number
Authorized official
MARIELA GUTIERREZ MEDICAL ASSISTANT (CLINIC SUPERVISOR)
(209) 522-9054
Entity
Organization

Contact information

Practice address
1130 COFFEE RD STE 10, MODESTO, CA 95355-4228
(209) 522-9054
(209) 522-2631
Mailing address
1130 COFFEE RD STE 10, MODESTO, CA 95355-4228
(209) 522-9054
(209) 522-2631

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
2084P0800X
Psychiatry Physician

Other

Enumeration date
10/17/2006
Last updated
08/13/2024
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