Provider Demographics
NPI:1467533737
Name:ASPEN FAMILY MEDICAL GROUP OF MODESTO, INC.
Entity Type:Organization
Organization Name:ASPEN FAMILY MEDICAL GROUP OF MODESTO, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:SALINAS
Authorized Official - Suffix:
Authorized Official - Credentials:LVN
Authorized Official - Phone:209-522-9054
Mailing Address - Street 1:2501 MCHENRY AVE STE F
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-3257
Mailing Address - Country:US
Mailing Address - Phone:209-522-9054
Mailing Address - Fax:209-522-2631
Practice Address - Street 1:2501 MCHENRY AVE STE F
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-3257
Practice Address - Country:US
Practice Address - Phone:209-522-9054
Practice Address - Fax:209-522-2631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty