Healthcare Provider Details

I. General information

NPI: 1003613704
Provider Name (Legal Business Name): COUNTY OF TUOLUMNE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2025
Last Update Date: 02/28/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12915 JUSTICE CENTER DRIVE
SONORA CA
95370
US

IV. Provider business mailing address

12915 JUSTICE CENTER DRIVE
SONORA CA
95370
US

V. Phone/Fax

Practice location:
  • Phone: 209-533-5855
  • Fax:
Mailing address:
  • Phone: 209-533-5855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. NEAL EVANS
Title or Position: UNDERSHERIFF
Credential:
Phone: 209-533-5855