Organization
THEODORE E. STAAHL MD INC
Active
Other names
MD Laser Center
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. NANCY STAAHL (ADMINISTRATOR/OFFICE MANAGER)
(209) 577-5700
Entity
Organization
Contact information
Practice address
1329 SPANOS CT, SUITE A-1, MODESTO, CA 95355-2806
(209) 577-5700
(209) 577-5968
Mailing address
1329 SPANOS CT, SUITE A-1, MODESTO, CA 95355-2806
(209) 577-5700
(209) 577-5968
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
G37452
CA
Other
Enumeration date
08/12/2010
Last updated
11/09/2022
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