Healthcare Provider Details

I. General information

NPI: 1548997422
Provider Name (Legal Business Name): GLORIFINO DEGALA JUAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2022
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 W HOSPITAL RD
FRENCH CAMP CA
95231-9693
US

IV. Provider business mailing address

10100 TRINITY PKWY STE 100
STOCKTON CA
95219-7239
US

V. Phone/Fax

Practice location:
  • Phone: 209-953-6400
  • Fax:
Mailing address:
  • Phone: 209-468-6820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP95027233
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: