Individual
JOSE GERARDO ALBERTO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
600 COFFEE RD, MODESTO, CA 95355-4201
(209) 521-6097
Mailing address
600 COFFEE RD, MODESTO, CA 95355-4201
(209) 521-6097
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
A133124
CA
207Q00000X
Family Medicine Physician
A133124
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CA158831
MEDICARE PTAN
CA
Enumeration date
06/06/2012
Last updated
07/21/2022
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