Aspen Family Medical Group of Modesto, Inc.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

Legal business name

ASPEN FAMILY MEDICAL GROUP OF MODESTO, INC.

Practice address

1130 Coffee Rd Ste 10
Modesto, CA 95355-4228

Phone

(559) 495-8659

NPI assigned

Aug 24, 2023

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mariela Gutierrez, MEDICAL ASSISTANT

Title

Clinic Supervisor

Phone

(209) 522-9054

Specialties & licenses 1

Addresses

Other names 1

• Premium Mental Health Services Doing business as

Tax ID family

Aspen Family Medical Group of Modesto Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Aspen Family Medical Group of Modesto, Inc.

  • Family Medicine Physician
  • Modesto, CA
  • NPI 1467533737
  NPD tax ID
• Aspen Family Medical Group of Modesto, Inc.

  • Urgent Care Clinic/Center
  • Modesto, CA
  • NPI 1497531719
  NPD tax ID

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1692835200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1723161600000",
    "number": "1689458051",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1130 COFFEE RD STE 10",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953554228",
            "telephone_number": "209-522-9054"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1130 COFFEE RD STE 10",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953554228",
            "telephone_number": "559-495-8659"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ASPEN FAMILY MEDICAL GROUP OF MODESTO, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-08-24",
        "last_updated": "2024-08-09",
        "certification_date": "2024-08-09",
        "status": "A",
        "authorized_official_last_name": "GUTIERREZ",
        "authorized_official_first_name": "MARIELA",
        "authorized_official_title_or_position": "CLINIC SUPERVISOR",
        "authorized_official_telephone_number": "209-522-9054",
        "authorized_official_credential": "MEDICAL ASSISTANT"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Premium Mental Health Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jennifer Ashlock
• Amin Ashrafzadeh, MD
• Aspen Family Medical Group of Modesto Inc.
• Aspen Family Medical Group of Modesto, Inc.
• Aspen Family Medical Group of Modesto, Inc.
• Aspiranet
• Aspiranet
• Aspiranet
• Aspiranet
• Aspiranet

• Psychiatry Physician in Modesto, CA
• Providers in Modesto, CA by specialty
• Psychiatry Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.