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General NPI Number Information
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NPI Number | 1790080067
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Entity Type | Organization
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Legal Business Name | SAN JOAQUIN COUNTY - HSA - ACS
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Dates
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Enumeration Date | 01/18/2011
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Last Update Date | 01/18/2011
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Provider Practice Location Address
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Address Line | 102 S SAN JOAQUIN ST
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City | STOCKTON
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State | CA
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Zip | 95202-3213
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Country | US
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Telephone | 209-465-8220
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Fax | 209-468-2207
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Provider Business Mailing Address
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Address Line | 102 S SAN JOAQUIN ST
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City | STOCKTON
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State | CA
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Zip | 95202-3213
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Country | US
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Telephone | 209-465-8220
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Fax | 209-468-2207
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Authorized Official
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Title or Position | SOCIAL WORKER
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Name | MR. LUIS ALVEREZ MAYORGA
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Credential |
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Telephone | 209-468-1721
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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