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General NPI Number Information
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NPI Number | 1619974219
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Entity Type | Organization
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Legal Business Name | ST. JOSEPH'S SURGERY CENTER LP
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Dates
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Enumeration Date | 06/28/2005
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Last Update Date | 10/23/2024
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Provider Practice Location Address
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Address Line | 1800 N CALIFORNIA ST STE 1
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City | STOCKTON
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State | CA
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Zip | 95204-6019
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Country | US
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Telephone | 209-467-6316
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Fax | 209-461-6895
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Provider Business Mailing Address
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Address Line | 1800 N CALIFORNIA ST STE 1
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City | STOCKTON
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State | CA
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Zip | 95204-6019
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Country | US
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Telephone | 209-467-6316
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Fax | 209-461-6895
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | ERIC BOON
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Credential |
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Telephone | 480-567-0269
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | EXEMPT FROM LICENSUR
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License Number State | CA
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