Healthcare Provider Details

I. General information

NPI: 1366210478
Provider Name (Legal Business Name): COMMUNITY MEDICAL TEAM ACUTE CARE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2023
Last Update Date: 02/26/2025
Certification Date: 02/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

768 MOUNTAIN RANCH RD
SAN ANDREAS CA
95249-9707
US

IV. Provider business mailing address

1801 E MARCH LN STE C300
STOCKTON CA
95210-6657
US

V. Phone/Fax

Practice location:
  • Phone: 209-915-6505
  • Fax: 209-464-0193
Mailing address:
  • Phone: 209-464-6422
  • Fax: 209-464-0193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: SANJEEV K GOSWAMI
Title or Position: PRESIDENT
Credential: MD
Phone: 209-310-6156