DERMATOLOGY AFFILIATES MEDICAL GROUP A PROFESSIONAL CORPORATION (NPI# 1558364869) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1558364869 |
| Entity Type | Organization |
| Organization Name | DERMATOLOGY AFFILIATES MEDICAL GROUP A PROFESSIONAL CORPORATION |
| Practice Address |
1324 Nelson Ave Ste B Modesto CA 95350-5341 |
| Practice Telephone | 2095249481 |
| Practice Fax Number | 2095249486 |
| Mailing Telephone | 2095249481 |
| Mailing Fax Number | 2095249486 |
| Enumeration Date | 2005-05-31 |
| Last Update Date | 2014-01-22 |
| Authorized Official Name | DR. CATHERINE A. BIREN (PRESIDENT) |
| Authorized Official Telephone | 2095249481 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 174400000X | Specialist | A19758 | CA | Other Service Providers |
| Street Address |
1324 NELSON AVE STE B |
| City | MODESTO |
| State | CA |
| Zip Code | 95350-5341 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124021035 | Catherine A Biren | Specialist | 1324 Nelson Ave, Ste B, Modesto, CA 95350-5341 | 2005-05-24 |
| 1770586414 | Robert G Walton | Specialist | 1324 Nelson Ave, Ste B, Modesto, CA 95350-5341 | 2005-05-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164020459 | Karina Montes Rodriguez | Case Manager/Care Coordinator | Cip 1540 Florida Ave, Suite 212, Modesto, CA 95350 | 2020-10-09 |
| 1134737315 | Dr. Jeffrey A. Saladin, Dental Corporation | Dentist | 2057 Tully Road, Suite A, Modesto, CA 95350 | 2020-07-14 |
| 1588211254 | Karla Junuen Toscano | Licensed Vocational Nurse | 1235 Mchenry Ave. Suites A&b, Modesto, CA 95350 | 2019-08-19 |
| 1831694769 | Loretta Myers-weber | Nurse Practitioner | 1510 Florida Ave Ste A, Modesto, CA 95350 | 2018-03-23 |
| 1720599632 | Coral Alejandra Amador | Counselor | 1700 Mchenry Village Way, Suite 11b, Modesto, CA 95350 | 2017-10-18 |
| 1053820522 | Pannu and Henne Dental Corp. | Dentist | 3219 Mc Henry Ave, Suite E, Modesto, CA 95350 | 2017-09-27 |
| 1346779709 | Kevin Sotelo | Behavior Technician | 2630 W Rumble Road, Modesto, CA 95350 | 2017-06-08 |
| 1255869566 | Hoa Xuan Phan | Family Medicine | 1441 Florida Ave Ste 200, Modesto, CA 95350 | 2017-05-31 |
| 1356881163 | Brady S Marshall | Dentist | 201 E. Orangeburg Avenue, Suite C, Modesto, CA 95350 | 2017-02-27 |
| 1750755476 | Caremore Health Plan | Nurse Practitioner | 1234 Mchenry Avenue, Modesto, CA 95350 | 2015-11-18 |
| Find all providers in zip 95350 | ||||
| Taxonomy Code | 174400000X |
| Grouping | Other Service Providers |
| Classification | Specialist |
| An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |
| Notes: Source: Expanded from Webster’s II New Riverside University Dictionary, Boston: Riverside Publishing Company, 1974. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881045763 | Maria Ortiz | Specialist | 1801 Tully Rd Ste A2, Modesto, CA 95350-2937 | 2016-06-22 |
| 1184081614 | James Mccray | Specialist | 1620 N Carpenter Rd Ste D59, Modesto, CA 95351-1148 | 2016-01-28 |
| 1922380518 | Thao Truong | Specialist | 1321 I St Ste #3, Modesto, CA 95354 | 2011-09-09 |
| 1497088173 | Heather Lee King | Specialist | 325 Downey Ave, Modesto, CA 95354-1203 | 2009-09-11 |
| 1073783353 | David Bautista | Specialist | 500 9th St, Modesto, CA 95354-3428 | 2008-03-03 |
| 1770622375 | Kathleen Marie Dubose | Specialist | 1901 Standiford Ave, Suite A, Modesto, CA 95350-0149 | 2007-02-06 |
| 1932266517 | Callie C Graham | Specialist | 1601 Yosemite Blvd, Suite A, Modesto, CA 95354-2800 | 2007-01-02 |
| 1295896041 | Theodore Edmund Staahl | Specialist | 1329 Spanos Ct Ste A-1, Modesto, CA 95355-2806 | 2006-12-13 |
| 1831272657 | John Leicham | Specialist | 200 Greenwich Ln, Modesto, CA 95350-1461 | 2006-10-23 |
| 1144310657 | Valley Hand Center | Specialist | 200 W Roseburg Ave, Ste B-1, Modesto, CA 95350-5200 | 2006-10-13 |
| Find all providers in MODESTO | ||||
Please comment or provide details below to improve the information on DERMATOLOGY AFFILIATES MEDICAL GROUP A PROFESSIONAL CORPORATION.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.