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General NPI Number Information
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NPI Number | 1952356909
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Entity Type | Organization
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Legal Business Name | SAN JOAQUIN HEMATOLOGY ONCOLOGY
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Dates
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Enumeration Date | 05/24/2006
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Last Update Date | 08/26/2011
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Provider Practice Location Address
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Address Line | 1801 E MARCH LN SUITE B260
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City | STOCKTON
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State | CA
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Zip | 95210-6629
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Country | US
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Telephone | 209-474-1458
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Fax | 209-474-1444
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Provider Business Mailing Address
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Address Line | PO BOX 7667
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City | STOCKTON
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State | CA
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Zip | 95267-0667
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | INMAN RENE GABRIELA
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Credential |
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Telephone | 209-474-1458
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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License Number | A708830
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License Number State | CA
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