Provider Demographics
NPI:1710488101
Name:MODESTO PAIN DIAGNOSTIC TREATMENT CENTER
Entity Type:Organization
Organization Name:MODESTO PAIN DIAGNOSTIC TREATMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:CATON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-491-5370
Mailing Address - Street 1:1524 MCHENRY AVE
Mailing Address - Street 2:SUITE 515
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350
Mailing Address - Country:US
Mailing Address - Phone:209-491-5370
Mailing Address - Fax:209-491-5379
Practice Address - Street 1:1524 MCHENRY AVE
Practice Address - Street 2:SUITE 505
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350
Practice Address - Country:US
Practice Address - Phone:209-326-1300
Practice Address - Fax:209-491-5379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-22
Last Update Date:2018-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty