Healthcare Provider Details

I. General information

NPI: 1295548832
Provider Name (Legal Business Name): DELTA CMT INPATIENT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2025
Last Update Date: 01/28/2025
Certification Date: 01/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 W ACACIA ST
STOCKTON CA
95203-2405
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 209-944-5550
  • Fax: 209-464-0193
Mailing address:
  • Phone: 209-464-6422
  • Fax: 209-464-0193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

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