=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922010222
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ST.JOSEPHS MEDICAL ASSOCIATES INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/13/2006
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1805 N CALIFORNIA ST STE 201
-----------------------------------------------------
City | STOCKTON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95204-6032
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-939-3840
-----------------------------------------------------
Fax | 209-463-4254
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1805 N CALIFORNIA ST STE 201
-----------------------------------------------------
City | STOCKTON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95204-6032
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-939-3840
-----------------------------------------------------
Fax | 209-463-4254
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | SHAUKAT A SHAH
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 209-939-3840
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------