JOSEPH JOHNNY PROVENZANO JR. (NPI# 1215993738) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1215993738 |
| Entity Type | Individual |
| Full Name | JOSEPH JOHNNY PROVENZANO JR. |
| Credential | DO |
| Practice Address |
3612 Dale Rd Modesto CA 95356-0500 |
| Mailing Address |
10470 Old Placerville Rd Ste 100 Sacramento CA 95827-2539 |
| Practice Telephone | 2095220146 |
| Mailing Telephone | 8004700071 |
| Enumeration Date | 2006-04-24 |
| Last Update Date | 2019-06-11 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 20A5427 | CA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | 00AX54270 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609869940 | Joseph M Provenzano | Internal Medicine | 906 S Federal Hwy, Boynton Beach, FL 33435-5671 | 2005-08-23 |
| Street Address |
3612 DALE RD |
| City | MODESTO |
| State | CA |
| Zip Code | 95356-0500 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205836160 | Kathie Lee Cronin | Family Medicine | 3612 Dale Rd, Modesto, CA 95356-0500 | 2005-07-21 |
| 1285093021 | Juan Barahona | Family Medicine | 3612 Dale Rd, Modesto, CA 95356-0500 | 2016-02-22 |
| 1851765184 | Sutter Valley Medical Foundation | Family Medicine | 3612 Dale Rd, Modesto, CA 95356-0500 | 2015-11-24 |
| 1114310687 | Hollie Gaeto | Family Medicine | 3612 Dale Rd, Modesto, CA 95356 | 2015-03-09 |
| 1790033678 | Jameel Michael Shahzada | Family Medicine | 3612 Dale Rd, Modesto, CA 95356-0500 | 2012-08-27 |
| 1790073419 | Ali Husain | Family Medicine | 3612 Dale Rd, Modesto, CA 95356-0500 | 2011-07-15 |
| 1669785861 | Karen Kou An Hsieh | Family Medicine | 3612 Dale Rd, Modesto, CA 95356-0500 | 2010-07-16 |
| 1093949703 | Divya Pannala | Family Medicine | 3612 Dale Rd, Modesto, CA 95356-0500 | 2009-05-08 |
| 1992749170 | Francis R Flaim | Family Medicine | 3612 Dale Rd, Modesto, CA 95356-0500 | 2006-06-16 |
| 1326093360 | Sutter Gould Medical Foundation | Family Medicine | 3612 Dale Rd, Modesto, CA 95356-0500 | 2006-05-24 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649809021 | Amelia E Delgadillo | Licensed Vocational Nurse | 501 Triangle Rd, Modesto, CA 95356 | 2020-04-07 |
| 1689220279 | Meagan Veneman | Physical Medicine & Rehabilitation | 125 Hogue Rd, Modesto, CA 95356 | 2019-08-10 |
| 1497131213 | Hermes Guardian Transport | Non-emergency Medical Transport (VAN) | 4221 Erin Way, Modesto, CA 95356 | 2015-08-04 |
| 1811373640 | Melissa Ruiz | Marriage & Family Therapist | 5815 Stoddard Rd Suite 600, Modesto, CA 95356 | 2015-08-04 |
| 1922242866 | Lifecare Solutions Inc | Durable Medical Equipment & Medical Supplies | 500 Glass Ln Ste H, Modesto, CA 95356 | 2009-04-22 |
| 1659541647 | Ashley Allison Streeter | Dentist | 556 Lyell Dr, Modesto, CA 95356 | 2008-03-05 |
| 1265636013 | Margaret Kathleen Grisell | Orthopaedic Surgery | 4601 Dale Ave, Kaiser Modesto Medical Center, Orthopedic Surgery, Modesto, CA 95356 | 2007-06-14 |
| 1841412111 | Bobby Gene Boswell | Specialist/Technologist | 3908 Vintage Cove, Modesto, CA 95356 | 2007-05-03 |
| 1598892861 | Merritt Radiological Medical Group Inc | Radiology | 526 Charity Way, Modesto, CA 95356 | 2007-02-27 |
| 1396871091 | Michael Steven Beck | Social Worker | 4640 Spyres Way, Building B, Suite 7, Modesto, CA 95356 | 2007-02-26 |
| Find all providers in zip 95356 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861091126 | Silvia Diego Md Inc A Professional Medical Corp | Family Medicine | 1317 Oakdale Rd Ste 100, Modesto, CA 95355-3362 | 2020-10-19 |
| 1104393362 | Binh T Dang Md Inc | Family Medicine | 2209 Coffee Rd Ste I, Modesto, CA 95355-2360 | 2018-10-25 |
| 1255869566 | Hoa Xuan Phan | Family Medicine | 1441 Florida Ave Ste 200, Modesto, CA 95350 | 2017-05-31 |
| 1164957486 | Progressive Urgent Care Inc | Family Medicine | 801 17th St, Modesto, CA 95354-1243 | 2017-04-24 |
| 1881039873 | Sabrina Arora-thissen | Family Medicine | 401 Paradise Rd. Ste, Modesto, CA 95351 | 2013-05-03 |
| 1467725473 | James L Stanton, Md Inc | Family Medicine | 200 B1 West Roseburg Avenue, Modesto, CA 95350 | 2012-02-22 |
| 1154698447 | Shashi .t Sood M.d., Inc | Family Medicine | 1401 Spanos Ct Ste 110, Modesto, CA 95355-2812 | 2011-11-30 |
| 1639408362 | Charlie Walker | Family Medicine | 1320 Celeste Drive, Modesto, CA 95355 | 2009-12-08 |
| 1871783142 | Jose Limon M.d. Inc. | Family Medicine | 1809 Bumgardner Ct, Modesto, CA 95355-9295 | 2007-08-01 |
| 1437375094 | Christianne Bishop | Family Medicine | 600 Coffee Road, Sutter Gould Medical Foundation, Modesto, CA 95355 | 2007-04-18 |
| Find all providers in MODESTO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.