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General NPI Number Information
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NPI Number | 1962369348
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Entity Type | Organization
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Legal Business Name | ALLERGY IMMUNOLOGY AND ASTHMA MEDICAL GROUP INC.
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Dates
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Enumeration Date | 01/07/2026
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Last Update Date | 01/07/2026
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Provider Practice Location Address
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Address Line | 4628 GEORGETOWN PL
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City | STOCKTON
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State | CA
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Zip | 95207-6204
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Country | US
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Telephone | 209-951-5353
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Fax | 209-951-5369
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Provider Business Mailing Address
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Address Line | 4628 GEORGETOWN PL
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City | STOCKTON
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State | CA
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Zip | 95207-6204
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Country | US
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Telephone | 209-951-5353
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Fax | 209-951-5369
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Authorized Official
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Title or Position | MANAGER
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Name | LEO F AGBULOS
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Credential | LVN
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Telephone | 209-951-5353
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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 |
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License Number State |
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