Active NPI
Manju Mathew
- Family Nurse Practitioner
- Modesto, CA
National Provider Identifier
1821872235
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 95025148
- Practice address
- 1608 Tully Rd
Modesto, CA 95350-4031 - Phone
- (209) 409-8589
- NPI assigned
- Aug 24, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 95025148 | CA | Primary |
Addresses
Primary practice location
1608 Tully Rd
Modesto, CA 95350-4031
Mailing address
2605 Prosperity Way
Modesto, CA 95355-8646
Phone (209) 202-4314
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 95025148 | CA | MD | Family Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1692835200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1692835200000",
"number": "1821872235",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2605 PROSPERITY WAY",
"city": "MODESTO",
"state": "CA",
"postal_code": "953558646",
"telephone_number": "209-202-4314"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1608 TULLY RD",
"city": "MODESTO",
"state": "CA",
"postal_code": "953504031",
"telephone_number": "209-409-8589"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MATHEW",
"first_name": "MANJU",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-08-24",
"last_updated": "2023-08-24",
"certification_date": "2023-08-24",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "CA",
"license": "95025148",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Modesto, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.