Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Providence Family Practice Medical Group

Organization Family Medicine Physician · NPI 1104979582

Providence Family Practice Medical Group is a Family Medicine Physician in Modesto, California. Registered with an NPI since 2007.

In the registry since
2007

Practice location Address checks out

1213 Coffee Rd Ste B
Modesto, CA 95355-4229
Phone: (209) 491-2500
Fax: (209) 491-2545
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X

Record details

NPI number1104979582
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Kathie Cronin — Managing Partner · (209) 491-2500
NPI enumeratedJanuary 19, 2007
Last updated in NPPESAugust 22, 2020
Mailing address1213 Coffee Rd, Suite B, Modesto, CA 95355-4229

Other providers in Modesto