Healthcare Provider Details

I. General information

NPI: 1326320680
Provider Name (Legal Business Name): SAN JOAQUIN COUNTY MENTAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2011
Last Update Date: 09/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1212 NORTH CALIFORNIA ST
STOCKTON CA
95202
US

IV. Provider business mailing address

1212 NORTH CALIFORNIA ST
STOCKTON CA
95202
US

V. Phone/Fax

Practice location:
  • Phone: 209-468-8720
  • Fax:
Mailing address:
  • Phone: 209-468-8720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number
License Number State

VIII. Authorized Official

Name: VIC SINGH
Title or Position: DIRECT
Credential:
Phone: 209-464-8660