JOSEPH JOHNNY PROVENZANO

MODESTO, CA
NPI1215993738
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy207Q00000X Family Medicine
(Licence: CA  20A5427)
Enumeration Date2006-04-24
Last Update Date2019-06-11
Business Address
JOSEPH JOHNNY PROVENZANO DO
3612 DALE RD
MODESTO, CA 95356-0500
Phone number: 209-522-0146
Mailing Address
JOSEPH JOHNNY PROVENZANO DO
10470 OLD PLACERVILLE RD STE 100
SACRAMENTO, CA 95827-2539
Phone number: 800-470-0071
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