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General NPI Number Information
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NPI Number | 1750474508
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Entity Type | Organization
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Legal Business Name | SAN JOAQUIN TOTALCARE
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5361 E. KINGS CANYON
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City | FRESNO
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State | CA
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Zip | 93727
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Country | US
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Telephone | 559-251-2225
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Fax | 559-251-9575
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Provider Business Mailing Address
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Address Line | 5361 E. KINGS CANYON
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City | FRESNO
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State | CA
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Zip | 93727
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Country | US
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Telephone | 559-251-2225
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Fax | 559-251-9575
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. GERALD HOOVER
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Credential | D.O.
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Telephone | 559-251-2225
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 20A6186
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License Number State | CA
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