Healthcare Provider Details

I. General information

NPI: 1689769986
Provider Name (Legal Business Name): SAN JOAQUIN COUNTY CCS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1616 CHESTER DR
TRACY CA
95376-2928
US

IV. Provider business mailing address

PO BOX 2009
STOCKTON CA
95201-2009
US

V. Phone/Fax

Practice location:
  • Phone: 209-831-5952
  • Fax:
Mailing address:
  • Phone: 209-831-5952
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. ARMANDO VALERIO
Title or Position: MTP MANAGER
Credential: PT,DPT
Phone: 209-953-3617