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General NPI Number Information
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NPI Number | 1669743274
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Entity Type | Organization
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Legal Business Name | STOCKTON PRIMARY CARE
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Dates
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Enumeration Date | 01/13/2012
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Last Update Date | 01/13/2012
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Provider Practice Location Address
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Address Line | 2068 SNOWBIRD DR
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City | LODI
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State | CA
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Zip | 95242-4754
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Country | US
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Telephone | 209-333-0259
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Fax | 209-333-0259
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Provider Business Mailing Address
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Address Line | 1805 N CALIFORNIA ST STE 102
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City | STOCKTON
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State | CA
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Zip | 95204-6032
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Country | US
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Telephone | 209-946-4000
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Fax | 209-946-4002
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Authorized Official
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Title or Position | FAMILY PRACTICE
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Name | DR. RAGUNATH K REDDY
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Credential | MD
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Telephone | 209-946-4000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 20440
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License Number State | CA
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