Organization
HERA OBGYN MEDICAL GROUP, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA HILL (OFFICE MANAGER)
(209) 521-4372
Entity
Organization
Contact information
Practice address
1552 COFFEE RD, 1ST FLOOR, MODESTO, CA 95355-3107
(209) 521-4372
(209) 523-2005
Mailing address
1552 COFFEE RD, 1ST FLOOR, MODESTO, CA 95355-3107
(209) 521-4372
(209) 523-2005
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR01402490
—
CA
01
—
ZZZ04654Z
BLUE SHIELD OF CA
CA
Enumeration date
07/30/2006
Last updated
02/24/2020
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