Basic Information
| Provider Information | |||||||||
| NPI: | 1326525650 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MERCED WOMENS CENTER FOR ADVANCED PELVIC SURGERY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 220 STANDIFORD AVE STE F | ||||||||
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| City: | MODESTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953501159 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2095795628 | ||||||||
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| Practice Location | |||||||||
| Address1: | 900 W OLIVE AVE STE A | ||||||||
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| City: | MERCED | ||||||||
| State: | CA | ||||||||
| PostalCode: | 95348 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2095795628 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2018 | ||||||||
| LastUpdateDate: | 07/23/2018 | ||||||||
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| AuthorizedOfficialLastName: | THOMAS | ||||||||
| AuthorizedOfficialFirstName: | DIANE | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4152861616 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VF0040X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Female Pelvic Medicine and Reconstructive Surgery |
No ID Information.