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General NPI Number Information
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NPI Number | 1801074737
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Entity Type | Organization
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Legal Business Name | STOCKTON NEUROLOGICAL MEDICAL CLINIC, INC
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Dates
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Enumeration Date | 02/01/2008
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Last Update Date | 02/01/2008
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Provider Practice Location Address
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Address Line | 2815 N CALIFORNIA ST
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City | STOCKTON
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State | CA
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Zip | 95204-3738
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Country | US
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Telephone | 209-466-3551
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Fax | 209-465-7437
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Provider Business Mailing Address
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Address Line | 2815 N CALIFORNIA ST
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City | STOCKTON
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State | CA
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Zip | 95204-3738
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Country | US
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Telephone | 209-466-3551
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Fax | 209-465-7437
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. WARREN DAVID CLIFT
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Credential | M.D.
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Telephone | 209-466-3551
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | G16430
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License Number State | CA
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