Healthcare Provider Details

I. General information

NPI: 1255765467
Provider Name (Legal Business Name): SCAN HEALTHCHECK ASSESSMENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2013
Last Update Date: 08/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

534 E PINE ST
STOCKTON CA
95204-5536
US

IV. Provider business mailing address

534 E PINE ST
STOCKTON CA
95204-5536
US

V. Phone/Fax

Practice location:
  • Phone: 562-989-8356
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberA41240
License Number StateCA

VIII. Authorized Official

Name: DR. DAN OSTERWEIL
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 562-989-8356