Provider Demographics
NPI:1760670988
Name:EDWARD L AUEN PHD M D INC
Entity Type:Organization
Organization Name:EDWARD L AUEN PHD M D INC
Other - Org Name:PRO HEALTH MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:LEONARD
Authorized Official - Last Name:AUEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, MD
Authorized Official - Phone:209-529-2052
Mailing Address - Street 1:1401 SPANOS CT
Mailing Address - Street 2:SUITE 122
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-2810
Mailing Address - Country:US
Mailing Address - Phone:209-529-2052
Mailing Address - Fax:209-529-0323
Practice Address - Street 1:1401 SPANOS CT
Practice Address - Street 2:SUITE 122
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-2810
Practice Address - Country:US
Practice Address - Phone:209-529-2052
Practice Address - Fax:209-529-0323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-12
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA50019174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF05313Medicare UPIN
CAZZZ18264ZMedicare PIN