Healthcare Provider Details

I. General information

NPI: 1619774213
Provider Name (Legal Business Name): MMM GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2025
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3639 MILL SPRINGS DR
STOCKTON CA
95219-3227
US

IV. Provider business mailing address

3639 MILL SPRINGS DR
STOCKTON CA
95219-3227
US

V. Phone/Fax

Practice location:
  • Phone: 209-594-6311
  • Fax:
Mailing address:
  • Phone: 209-594-6311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MARCELINO MIRELES
Title or Position: CEO
Credential:
Phone: 209-594-6311