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General NPI Number Information
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NPI Number | 1821971888
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Entity Type | Organization
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Legal Business Name | EL PORTALITO
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Dates
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Enumeration Date | 07/28/2025
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Last Update Date | 07/28/2025
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Provider Practice Location Address
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Address Line | 1149 E MARKET ST
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City | STOCKTON
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State | CA
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Zip | 95205-5525
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Country | US
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Telephone | 209-647-9904
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Fax |
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Provider Business Mailing Address
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Address Line | 3934 JESSICA CT
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City | STOCKTON
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State | CA
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Zip | 95206-6444
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Country | US
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Telephone | 209-647-9904
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. JUAN ENRIQUE CEJA
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Credential |
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Telephone | 209-647-9904
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174200000X
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Taxonomy Name | Meals Provider
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License Number |
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License Number State |
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