Healthcare Provider Details

I. General information

NPI: 1467820019
Provider Name (Legal Business Name): SAN JOAQUIN COUNTY BHS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2015
Last Update Date: 10/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1149 N. EL DORADO ST.
STOCKTON CA
95205
US

IV. Provider business mailing address

1149 N. EL DORADO ST.
STOCKTON CA
95205
US

V. Phone/Fax

Practice location:
  • Phone: 209-468-2337
  • Fax:
Mailing address:
  • Phone: 209-468-2337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MR. ALMASTRO JOHN DENNY JR.
Title or Position: PEER PARTNER
Credential:
Phone: 209-468-2337