Basic Information
| Provider Information | |||||||||
| NPI: | 1164768982 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | O & D SURGICAL AND MEDICAL SOLUTIONS INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 140 EAST GRAGER AVENUE | ||||||||
| Address2: | SUITE B | ||||||||
| City: | MODESTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953504347 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2095891500 | ||||||||
| FaxNumber: | 2095210813 | ||||||||
| Practice Location | |||||||||
| Address1: | 140 EAST GRAGER AVENUE | ||||||||
| Address2: | SUITE B | ||||||||
| City: | MODESTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953504347 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2095891500 | ||||||||
| FaxNumber: | 2095210813 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/26/2012 | ||||||||
| LastUpdateDate: | 12/26/2012 | ||||||||
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| AuthorizedOfficialLastName: | DEL VALLE | ||||||||
| AuthorizedOfficialFirstName: | JUAN | ||||||||
| AuthorizedOfficialMiddleName: | JORGE | ||||||||
| AuthorizedOfficialTitleorPosition: | C.E.O. | ||||||||
| AuthorizedOfficialTelephone: | 2096141445 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | A81970 | CA | Y | Hospitals | General Acute Care Hospital |
No ID Information.