MEDICARE: SANGER WALK-IN CLINIC & WELLNESS CENTER

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	207Q00000X	Family Medicine Physician	G12981	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ZZZ04986Z	OTHER	CA	MEDICARE GROUP #

General Provider Information

NPI Number	:	1982823878
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SANGER WALK-IN CLINIC & WELLNESS CENTER

Provider Business Mailing Address
First Line	:	2535 JENSEN AVE
Second Line	:
City	:	SANGER
State	:	CA
Zip	:	93657-2288
Country	:	US
Telephone Number	:	559-876-6070
Fax Number	:	559-876-6078

Provider Business Practice Location Address
First Line	:	2535 JENSEN AVE
Second Line	:
City	:	SANGER
State	:	CA
Zip	:	93657-2288
Country	:	US
Telephone Number	:	559-876-6070
Fax Number	:	559-876-6078

Authorized Official
Title or Position	:	OWNER
Name	:	MR. JOSEPH I IDONI
Credential	:	PA
Telephone Number	:	559-876-6070

Provider Enumeration Date	:	04/25/2007
Last Update Date	:	04/09/2008

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Directions to “SANGER WALK-IN CLINIC & WELLNESS CENTER ” Practice Location

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