SAN JOAQUIN LASER AND SURGERY CENTER INC (NPI# 1730112178) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1730112178 |
| Entity Type | Organization |
| Organization Name | SAN JOAQUIN LASER AND SURGERY CENTER INC |
| Practice Address |
1805 N California St Ste 101a Stockton CA 95204-6032 |
| Mailing Address |
1144 Norman Dr Suite 102 Manteca CA 95336-5925 |
| Practice Telephone | 2099485515 |
| Mailing Telephone | 2098231152 |
| Mailing Fax Number | 2098233376 |
| Enumeration Date | 2006-07-09 |
| Last Update Date | 2015-09-08 |
| Authorized Official Name | SUSAN K FORD (ADMINISTRATOR) |
| Authorized Official Telephone | 2099485515 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QA1903X |
Clinic/Center Specialization: Ambulatory Surgical |
030000469 | CA | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | GROUP PTAN | ZZZ17148Z | 01 |
| Street Address |
1805 N CALIFORNIA ST STE 101A |
| City | STOCKTON |
| State | CA |
| Zip Code | 95204-6032 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962027524 | Kariem Abdelwahed | Licensed Vocational Nurse | 1630 N. Edison St Stockton Ca, Stockton, CA 95204 | 2020-06-10 |
| 1831730555 | Ronnie C Murray | Counselor | 1947 North California Street, Stockton, CA 95204 | 2019-10-03 |
| 1235614116 | Michelle Ann Horn | Marriage & Family Therapist | 3666 Mission Rd, Stockton, CA 95204 | 2018-09-26 |
| 1356830947 | Stockton Pace | PACE Provider Organization | 582 E. Harding Way, Stockton, CA 95204 | 2018-05-09 |
| 1790228781 | Rebecca Phongsa | Counselor | 1947 North Calfornia Street, Suite B, Stockton, CA 95204 | 2016-11-23 |
| 1700332905 | Serim Kang | Driver | 4222 N Pershing Ave, Suite D2, Stockton, CA 95204 | 2016-08-28 |
| 1033565544 | Philip John Brereton | Orthotist | 466 E Harding Way, Stockton, CA 95204 | 2016-05-13 |
| 1932507522 | David Grayson | Counselor | 1621 Brookside Rd, Stockton, CA 95204 | 2014-12-12 |
| 1174934897 | Gurtej Malhi | Internal Medicine | 1901 N California Street, Stockton, CA 95204 | 2014-05-15 |
| 1396156170 | Rajesh Saini | Nurse Practitioner | 1805 N California St. Suite 102, Stockton, CA 95204 | 2014-05-14 |
| Find all providers in zip 95204 | ||||
| Taxonomy Code | 261QA1903X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Ambulatory Surgical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922625995 | National Surgical Centers Stockton, LLC | Clinic/Center | 415 E Harding Way Ste E, Stockton, CA 95204-6118 | 2020-06-25 |
| 1316190796 | Sutter Gould Medical Foundation | Clinic/Center | 8011 Don Ave, Stockton, CA 95209 | 2008-10-29 |
| 1609041813 | Dental Surgery Centers of America | Clinic/Center | 1523 E March Ln Ste A, Stockton, CA 95210-5607 | 2008-04-29 |
| 1225138647 | American Dental Surgery Centers, Inc. | Clinic/Center | 1523 E. March Ln., Suite 100, Stockton, CA 95210-5663 | 2006-09-25 |
| 1245285857 | Ambulatory Surgery Center of Eager Steven E Md Gen Ptr | Clinic/Center | 2388 N California St, Stockton, CA 95204-5506 | 2006-05-23 |
| 1619974219 | St. Joseph's Surgery Center Lp | Clinic/Center | 1800 N California St, Ste 1, Stockton, CA 95204-6019 | 2005-06-28 |
| 1417405234 | Psc Stockton Outpatient Surgery Center, LLC | Clinic/Center | 1805 N California St, Suite 405, Stockton, CA 95204-6037 | 2016-09-21 |
| 1467825844 | Sutter Valley Medical Foundation | Clinic/Center | 8011 Don Ave, Stockton, CA 95209-2841 | 2015-11-05 |
| 1598158487 | California Street Outpatient Surgery Center, LLC | Clinic/Center | 1805 N California St, Suite 405, Stockton, CA 95204-6037 | 2015-03-17 |
| 1982942298 | Stockton Outpatient Surgery Center LLC | Clinic/Center | 2388 N California St, Stockton, CA 95204-5506 | 2013-01-21 |
| Find all providers in STOCKTON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.