Healthcare Provider Details

I. General information

NPI: 1215573613
Provider Name (Legal Business Name): TOURO UNIVERSITY MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2019
Last Update Date: 05/22/2023
Certification Date: 05/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1805 N CALIFORNIA ST STE 201
STOCKTON CA
95204-6032
US

IV. Provider business mailing address

1805 N CALIFORNIA ST STE 201
STOCKTON CA
95204-6032
US

V. Phone/Fax

Practice location:
  • Phone: 209-645-4005
  • Fax: 209-645-6344
Mailing address:
  • Phone: 209-645-4005
  • Fax: 209-645-6344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. RICHARD BRIAN RIEMER
Title or Position: VICE-PRESIDENT
Credential: DO
Phone: 209-645-4005