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General NPI Number Information
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NPI Number | 1992652861
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Entity Type | Organization
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Legal Business Name | COMMUNITY MEDICAL CENTERS INC
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Dates
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Enumeration Date | 03/11/2026
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Last Update Date | 03/11/2026
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Provider Practice Location Address
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Address Line | 200 COTTAGE AVE STE 202
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City | MANTECA
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State | CA
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Zip | 95336-4935
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Country | US
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Telephone | 209-624-5800
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Fax |
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Provider Business Mailing Address
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Address Line | 7210 MURRAY DR
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City | STOCKTON
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State | CA
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Zip | 95210-3339
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Country | US
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Telephone | 209-373-2800
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | GREGORY ALAN DIEDERICH
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Credential |
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Telephone | 209-689-4066
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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