Healthcare Provider Details

I. General information

NPI: 1427629203
Provider Name (Legal Business Name): SAN JOAQUIN COUNTY WHOLE PERSON CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2021
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7000 MICHAEL CANLIS WAY
FRENCH CAMP CA
95231-9781
US

IV. Provider business mailing address

7000 MICHAEL CANLIS WAY
FRENCH CAMP CA
95231-9781
US

V. Phone/Fax

Practice location:
  • Phone: 209-468-4550
  • Fax: 209-468-5274
Mailing address:
  • Phone: 209-468-4550
  • Fax: 209-468-5274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: LAKISHA HOLTON
Title or Position: CHS ADMINISTRATOR
Credential: DNP, APRN, FNP-C
Phone: 209-468-4487