MEDICARE: STOCKTON NEUROLOGICAL MEDICAL CLINIC, INC

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
1	174400000X	Specialist	G16430	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1801074737
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STOCKTON NEUROLOGICAL MEDICAL CLINIC, INC

Provider Business Mailing Address
First Line	:	2815 N CALIFORNIA ST
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95204-3738
Country	:	US
Telephone Number	:	209-466-3551
Fax Number	:	209-465-7437

Provider Business Practice Location Address
First Line	:	2815 N CALIFORNIA ST
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95204-3738
Country	:	US
Telephone Number	:	209-466-3551
Fax Number	:	209-465-7437

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. WARREN DAVID CLIFT
Credential	:	M.D.
Telephone Number	:	209-466-3551

Provider Enumeration Date	:	02/01/2008
Last Update Date	:	02/01/2008

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