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NPI Code Detail

MEDICARE: SAN JOAQUIN COUNTY PUBLIC HEALTH WAIVER

MEDICARE: SAN JOAQUIN COUNTY PUBLIC HEALTH WAIVER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251K00000XPublic Health or Welfare Agency

General Provider Information

NPI Number : 1215070636
Entity Type Code : Organization
Provider Name (Legal Business Name) : SAN JOAQUIN COUNTY PUBLIC HEALTH WAIVER
Provider Business Mailing Address
First Line : PO BOX 2009
Second Line :
City : STOCKTON
State : CA
Zip : 95201-2009
Country : US
Telephone Number : 209-468-3413
Fax Number : 209-468-3072
Provider Business Practice Location Address
First Line : 1601 E HAZELTON AVE
Second Line :
City : STOCKTON
State : CA
Zip : 95205-6229
Country : US
Telephone Number : 209-468-3413
Fax Number : 209-468-3072
Authorized Official
Title or Position : DIRECTOR PUBLIC HEALTH SERVICES
Name : MR. WILLIAM MITCHELL
Credential : MPH
Telephone Number : 209-468-3413
Provider Enumeration Date : 02/15/2007
Last Update Date : 08/22/2020

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Directions to “SAN JOAQUIN COUNTY PUBLIC HEALTH WAIVER ” Practice Location

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