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General NPI Number Information
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NPI Number | 1710172721
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Entity Type | Organization
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Legal Business Name | SAN JOAQUIN PRIME CARE MEDICAL GROUP INC.
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Dates
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Enumeration Date | 09/12/2007
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Last Update Date | 04/24/2015
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Provider Practice Location Address
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Address Line | 826 E MANNING AVE
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City | REEDLEY
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State | CA
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Zip | 93654-2232
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Country | US
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Telephone | 559-638-0400
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Fax | 559-638-0403
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Provider Business Mailing Address
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Address Line | 330 E PINE ST
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City | EXETER
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State | CA
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Zip | 93221-1838
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Country | US
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Telephone | 559-592-2134
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Fax | 559-592-5017
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Authorized Official
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Title or Position | BILLING SUPERVISOR
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Name | KIMBERLY BURGINS
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Credential |
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Telephone | 559-783-1181
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A43893
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License Number State | CA
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