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NPI Code Detail

MEDICARE: MR. DA HER

MEDICARE: MR. DA HER
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
1261QM2800XMethadone Clinic

General Provider Information

NPI Number : 1285797514
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. DA HER
Provider Business Mailing Address
First Line : 1456 MANIAGO DR
Second Line :
City : STOCKTON
State : CA
Zip : 95206-3882
Country : US
Telephone Number : 209-298-0887
Fax Number :
Provider Business Practice Location Address
First Line : 1111 N EL DORADO ST
Second Line :
City : STOCKTON
State : CA
Zip : 95202-1305
Country : US
Telephone Number : 209-938-0228
Fax Number : 209-938-0281
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/18/2006
Last Update Date : 07/08/2007

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Directions to “ MR. DA HER ” Practice Location

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