Healthcare Provider Details

I. General information

NPI: 1710279781
Provider Name (Legal Business Name): JOHN GABRIEL SISNEROZ M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2011
Last Update Date: 04/19/2022
Certification Date: 04/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 W. HOSPITAL ROAD
FRENCH CAMP CA
95231-3809
US

IV. Provider business mailing address

10100 TRINITY PKWY STE 100
STOCKTON CA
95219-7239
US

V. Phone/Fax

Practice location:
  • Phone: 209-953-3741
  • Fax: 209-953-9199
Mailing address:
  • Phone: 209-953-3741
  • Fax: 209-953-9199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: