Healthcare Provider Details

I. General information

NPI: 1265768980
Provider Name (Legal Business Name): VALLEY PERINATAL & GENETICS DIAGNOSTIC CENTER MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2009
Last Update Date: 03/25/2025
Certification Date: 03/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1617 N CALIFORNIA ST STE 2D
STOCKTON CA
95204-6117
US

IV. Provider business mailing address

P.O. BOX 967
LODI CA
95241-0967
US

V. Phone/Fax

Practice location:
  • Phone: 209-933-9888
  • Fax: 209-933-9988
Mailing address:
  • Phone: 209-334-1800
  • Fax: 209-334-2416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberG46081
License Number StateCA

VIII. Authorized Official

Name: JASBIR GILL
Title or Position: PRESIDENT
Credential: MD
Phone: 209-334-6583