Healthcare Provider Details

I. General information

NPI: 1336825371
Provider Name (Legal Business Name): ALBERT D CAREY II
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2023
Last Update Date: 06/26/2023
Certification Date: 06/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 W HOSPITAL RD
FRENCH CAMP CA
95231-9693
US

IV. Provider business mailing address

2356 WAGNER HEIGHTS RD
STOCKTON CA
95209-1738
US

V. Phone/Fax

Practice location:
  • Phone: 209-468-6857
  • Fax: 209-468-6739
Mailing address:
  • Phone: 510-987-6817
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License NumberA1599692
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: