Healthcare Provider Details

I. General information

NPI: 1841780301
Provider Name (Legal Business Name): SAN JOAQUIN CRITICAL CARE MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2018
Last Update Date: 10/29/2025
Certification Date: 10/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

4401 W MEMORIAL RD STE 121
OKLAHOMA CITY OK
73134-1722
US

V. Phone/Fax

Practice location:
  • Phone: 209-464-6422
  • Fax: 209-464-0193
Mailing address:
  • Phone: 405-751-4664
  • Fax: 405-751-3183

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number4061528
License Number StateCA

VIII. Authorized Official

Name: DR. SANJEEV K GOSWAMI
Title or Position: PRESIDENT
Credential: MD
Phone: 209-464-6422