MEDICARE: TOURO UNIVERSITY MEDICAL GROUP

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	2084P0804X	Child & Adolescent Psychiatry Physician
2	2084N0400X	Neurology Physician
3	2084N0600X	Clinical Neurophysiology Physician
4	2084P0800X	Psychiatry Physician
5	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1215573613
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOURO UNIVERSITY MEDICAL GROUP

Provider Business Mailing Address
First Line	:	1805 N CALIFORNIA ST STE 201
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95204-6032
Country	:	US
Telephone Number	:	209-645-4005
Fax Number	:	209-645-6344

Provider Business Practice Location Address
First Line	:	1805 N CALIFORNIA ST STE 201
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95204-6032
Country	:	US
Telephone Number	:	209-645-4005
Fax Number	:	209-645-6344

Authorized Official
Title or Position	:	VICE-PRESIDENT
Name	:	DR. RICHARD BRIAN RIEMER
Credential	:	DO
Telephone Number	:	209-645-4005

Provider Enumeration Date	:	11/20/2019
Last Update Date	:	02/11/2026

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