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NPI Code Detail

MEDICARE: UNIVERSITY OF THE PACIFIC

MEDICARE: UNIVERSITY OF THE PACIFIC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261Q00000XClinic/Center

General Provider Information

NPI Number : 1922105824
Entity Type Code : Organization
Provider Name (Legal Business Name) : UNIVERSITY OF THE PACIFIC
Provider Business Mailing Address
First Line : 1041 BROOKSIDE RD COWELL WELLNESS CENTER
Second Line :
City : STOCKTON
State : CA
Zip : 95211-0110
Country : US
Telephone Number : 209-946-2315
Fax Number : 209-946-3001
Provider Business Practice Location Address
First Line : 3601 PACIFIC AVE
Second Line :
City : STOCKTON
State : CA
Zip : 95211-0110
Country : US
Telephone Number : 209-946-2315
Fax Number : 209-946-3001
Authorized Official
Title or Position : EMR ADMINISTRATOR
Name : RANAI KOCH
Credential : MBA
Telephone Number : 209-946-2994
Provider Enumeration Date : 09/20/2006
Last Update Date : 11/13/2017

Similar Medicare Providers

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1124109350 — HOWARD H. CHI D.M.D.
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1821133281 — MRS. JANET BERNADETTE JONES R.N.,P.H.N., F.N.P.
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Directions to “UNIVERSITY OF THE PACIFIC ” Practice Location

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