Modesto Neonatal Medical Group, Inc.

Primary specialty

Neonatal-Perinatal Medicine PhysicianTaxonomy code 2080N0001X

License

39491 Issued in CA

Legal business name

MODESTO NEONATAL MEDICAL GROUP, INC.

Practice address

1441 Florida Ave
Modesto, CA 95350-4405

Phone

(209) 571-8330

NPI assigned

Aug 1, 2007

Last updated

Aug 1, 2007By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Gina Wallace

Title

Billing Agent

Phone

(209) 571-8330

Specialties & licenses 1

Addresses

Other identifiers 2

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

{
    "created_epoch": "1185926400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1185926400000",
    "number": "1912197294",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 577558",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953577558",
            "telephone_number": "209-571-8330",
            "fax_number": "209-491-7184"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1441 FLORIDA AVE",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953504405",
            "telephone_number": "209-571-8330"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODESTO NEONATAL MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-01",
        "last_updated": "2007-08-01",
        "status": "A",
        "authorized_official_last_name": "WALLACE",
        "authorized_official_first_name": "GINA",
        "authorized_official_title_or_position": "BILLING AGENT",
        "authorized_official_telephone_number": "209-571-8330",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "2080N0001X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Neonatal-Perinatal Medicine",
            "state": "CA",
            "license": "39491",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "ZZZ39491Z",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0090580",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Modesto Kidney Center, LLC (U.S. Renal Care Modesto Dialysis)
• Modesto Kidney Medical Group
• Modesto Mental Health Consultants Inc a Professional Medical Corp
• Modesto Mobility Center Inc.
• Modesto Natural Birth Place
• Modesto on-Call Services, LLC
• Modesto Optometric Vision Center Inc a Professional Optometric Corp
• Modesto Orthopedic Group
• Modesto Orthopedic Medical Group (Modesto Orthopedic Group)
• Modesto Pain Diagnostic Treatment Center

• Neonatal-Perinatal Medicine Physician in Modesto, CA
• Providers in Modesto, CA by specialty
• Neonatal-Perinatal Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2007; 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.