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
(559) 495-8659
Mailing address
1130 COFFEE RD STE 10, MODESTO, CA 95355-4228
(209) 522-9054
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
—
—
Other
Enumeration date
08/24/2023
Last updated
08/09/2024
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