1669578340 NPI number — CORNERSTONE FAMILY MEDICAL GROUP.

Table of content: (NPI 1669578340)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669578340 NPI number — CORNERSTONE FAMILY MEDICAL GROUP.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CORNERSTONE FAMILY MEDICAL GROUP.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CORNERSTONE FAMILY PRACTICE MEDICAL GROUP
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1669578340
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/16/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1444 FLORIDA AVE
Provider Second Line Business Mailing Address:
SUITE 202
Provider Business Mailing Address City Name:
MODESTO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95350-4400
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
209-524-1264
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1444 FLORIDA AVE
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
MODESTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95350-4400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-524-1264
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MCGREW
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
209-524-1264

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com