Healthcare Provider Details

I. General information

NPI: 1134472772
Provider Name (Legal Business Name): RIPON PRIMARY & URGENT CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2012
Last Update Date: 10/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

336 W MAIN ST
RIPON CA
95366-2424
US

IV. Provider business mailing address

336 W MAIN ST
RIPON CA
95366-2424
US

V. Phone/Fax

Practice location:
  • Phone: 209-599-5571
  • Fax: 209-253-0700
Mailing address:
  • Phone: 209-599-5571
  • Fax: 209-253-0700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP19879
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA71429
License Number StateCA

VIII. Authorized Official

Name: BHUMIKA DUNLAP
Title or Position: OFFICE MANAGER
Credential:
Phone: 209-599-5571