Individual
SEPIDEH MAFTOUN-BANANKHAH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
4301 N STAR WAY, MODESTO, CA 95356-9262
(209) 577-1200
(209) 577-6517
Mailing address
PO BOX 576768, MODESTO, CA 95357-6768
(209) 577-1200
(209) 577-6517
Taxonomy
Speciality
Code
Description
License number
State
207ZC0500X
Cytopathology Physician
A109216
CA
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
A109216
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
BP1-0018061
INSTITUTIONAL PERMIT
—
Enumeration date
06/11/2007
Last updated
07/21/2022
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