Healthcare Provider Details

I. General information

NPI: 1346710910
Provider Name (Legal Business Name): ANTHONY MERTENS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2018
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1212 N CALIFORNIA ST
STOCKTON CA
95202-1552
US

IV. Provider business mailing address

1112 CASTLE OAKS DR
STOCKTON CA
95210-2030
US

V. Phone/Fax

Practice location:
  • Phone: 209-468-8750
  • Fax:
Mailing address:
  • Phone: 209-406-2702
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberMPSS-HBPDGW
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: