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General NPI Number Information
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NPI Number | 1770807901
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Entity Type | Organization
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Legal Business Name | STOCKTON MEDICAL WEIGHT LOSS CENTER INC
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Dates
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Enumeration Date | 03/17/2010
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Last Update Date | 03/17/2010
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Provider Practice Location Address
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Address Line | 1801 E. MARCH LANE SUITE 400D
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City | STOCKTON
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State | CA
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Zip | 95210
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Country | US
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Telephone | 209-242-3334
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Fax |
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Provider Business Mailing Address
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Address Line | 1801 E. MARCH LANE SUITE 400D
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City | STOCKTON
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State | CA
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Zip | 95210
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Country | US
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Telephone | 209-242-3334
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. DAREN STEPHEN PRIMACK
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Credential | MD
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Telephone | 209-242-3334
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RB0002X
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Taxonomy Name | Obesity Medicine (Internal Medicine) Physician
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License Number | G68135
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License Number State | CA
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