Healthcare Provider Details

I. General information

NPI: 1609867787
Provider Name (Legal Business Name): COMMUNITY MEDICAL CENTERS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2005
Last Update Date: 04/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 N CENTRAL AVE
TRACY CA
95376-4104
US

IV. Provider business mailing address

7210 MURRAY DRIVE PO BOX 770
STOCKTON CA
95210-3339
US

V. Phone/Fax

Practice location:
  • Phone: 209-820-1525
  • Fax: 209-820-1525
Mailing address:
  • Phone: 209-373-2800
  • Fax: 209-373-2878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number030000423
License Number StateCA

VIII. Authorized Official

Name: MRS. CHRISTINE C NOGUERA
Title or Position: CEO
Credential:
Phone: 209-373-2831