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General NPI Number Information
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NPI Number | 1679023980
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Entity Type | Organization
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Legal Business Name | COUNTY OF SAN JOAQUIN
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Dates
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Enumeration Date | 10/11/2016
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Last Update Date | 06/02/2021
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Provider Practice Location Address
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Address Line | 1601 E HAZELTON AVE
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City | STOCKTON
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State | CA
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Zip | 95205-6229
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Country | US
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Telephone | 209-468-6937
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Fax | 209-468-7042
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Provider Business Mailing Address
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Address Line | PO BOX 1020
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City | STOCKTON
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State | CA
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Zip | 95201-3120
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Country | US
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Telephone | 209-468-6937
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Fax | 209-468-7042
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Authorized Official
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Title or Position | DIRECTOR OF AMBULATORY CARE SERVICE
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Name | MR. DAVID B JOMAOAS
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Credential |
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Telephone | 209-468-6160
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | 030000087
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License Number State | CA
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