Healthcare Provider Details

I. General information

NPI: 1386648780
Provider Name (Legal Business Name): TURLOCK WOMENS MED GRP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2141 COLORADO AVE
TURLOCK CA
95382-2011
US

IV. Provider business mailing address

2141 COLORADO AVE
TURLOCK CA
95382-2011
US

V. Phone/Fax

Practice location:
  • Phone: 209-668-2311
  • Fax: 209-668-8627
Mailing address:
  • Phone: 209-668-2311
  • Fax: 209-668-8627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberC34772
License Number StateCA

VIII. Authorized Official

Name: JAMES T LILLIGREN
Title or Position: PRESIDENT
Credential: MD
Phone: 209-668-2311