Healthcare Provider Details

I. General information

NPI: 1639875354
Provider Name (Legal Business Name): COMMUNITY MEDICAL CENTERS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2023
Last Update Date: 02/03/2023
Certification Date: 02/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2151 W GRANT LINE RD STE 138
TRACY CA
95377-7309
US

IV. Provider business mailing address

7210 MURRAY DR
STOCKTON CA
95210-3339
US

V. Phone/Fax

Practice location:
  • Phone: 209-944-4730
  • Fax:
Mailing address:
  • Phone: 209-373-2800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINE NOGUERA
Title or Position: CEO
Credential:
Phone: 220-373-2831