Healthcare Provider Details

I. General information

NPI: 1619040102
Provider Name (Legal Business Name): COUNTY OF SAN JOAQUIN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 08/24/2022
Certification Date: 08/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 W. HOSPITAL RD.
FRENCH CAMP CA
95231
US

IV. Provider business mailing address

PO BOX 1020
STOCKTON CA
95201-3120
US

V. Phone/Fax

Practice location:
  • Phone: 209-468-6937
  • Fax: 209-468-7042
Mailing address:
  • Phone: 209-468-6937
  • Fax: 209-468-7042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZB0001X
TaxonomyBlood Banking & Transfusion Medicine Physician
License Number05D0609571
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License Number05D0609571
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207ZH0000X
TaxonomyHematology (Pathology) Physician
License Number05D0609571
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code207ZM0300X
TaxonomyMedical Microbiology Physician
License Number05D0609571
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number05D0609571
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number05D0609571
License Number StateCA
# 7
Primary TaxonomyN
Taxonomy Code207ZP0104X
TaxonomyChemical Pathology Physician
License Number05D0609571
License Number StateCA
# 8
Primary TaxonomyY
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License Number05D0609571
License Number StateCA

VIII. Authorized Official

Name: MRS. SHEELA KAPRE
Title or Position: CHIEF MEDICAL OFFICER
Credential: MD, FCCP, FACP
Phone: 209-468-6600