Individual
DORIS SHORT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RADT 1
Contact information
Practice address
1620 CUMMINS DR, MODESTO, CA 95358-6400
(209) 576-1750
Mailing address
1620 CUMMINS DR, MODESTO, CA 95358-6400
(209) 576-1750
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
—
—
175T00000X
Peer Specialist
Primary
MPSS-LMKCTP
CA
Other
Enumeration date
03/03/2020
Last updated
12/11/2023
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