Healthcare Provider Details

I. General information

NPI: 1679383566
Provider Name (Legal Business Name): MINERALS BATHS COMMUNITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2025
Last Update Date: 01/13/2025
Certification Date: 01/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

323 W 7TH ST
STOCKTON CA
95206-2501
US

IV. Provider business mailing address

PO BOX 6951
STOCKTON CA
95206-1061
US

V. Phone/Fax

Practice location:
  • Phone: 510-292-1337
  • Fax:
Mailing address:
  • Phone: 510-292-1337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MS. PATRICIA BARRETT
Title or Position: CEO
Credential:
Phone: 510-292-1337