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General NPI Number Information
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NPI Number | 1497785455
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Entity Type | Organization
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Legal Business Name | SAN JOAQUIN CARDIOLOGY MEDICAL GROUP INC
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Dates
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Enumeration Date | 07/04/2006
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Last Update Date | 01/11/2011
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Provider Practice Location Address
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Address Line | 2800 N CALIFORNIA ST STE 14
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City | STOCKTON
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State | CA
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Zip | 95204-3759
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Country | US
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Telephone | 209-942-1005
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Fax | 209-942-0455
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Provider Business Mailing Address
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Address Line | 2800 N CALIFORNIA ST SUITE 14
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City | STOCKTON
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State | CA
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Zip | 95204
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Country | US
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Telephone | 209-942-1005
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Fax | 209-942-0455
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. PATTY S BALDERSTON
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Credential |
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Telephone | 209-942-1005
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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