Healthcare Provider Details

I. General information

NPI: 1164087268
Provider Name (Legal Business Name): COMMUNITY MEDICAL CENTERS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2019
Last Update Date: 07/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2415 W VINE ST STE 105
LODI CA
95242-3731
US

IV. Provider business mailing address

7210 MURRAY DR
STOCKTON CA
95210-3339
US

V. Phone/Fax

Practice location:
  • Phone: 209-333-3121
  • Fax:
Mailing address:
  • Phone: 209-373-2800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: MRS. CHRISTINE NOGUERA
Title or Position: CEO
Credential:
Phone: 209-373-2831