BRANDON JAY BACCAM (NPI# 1740820786) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1740820786 |
| Entity Type | Individual |
| Full Name | BRANDON JAY BACCAM |
| Practice Address |
3302 Rutherford Dr Stockton CA 95212-3425 |
| Practice Telephone | 2099546856 |
| Mailing Telephone | 2099546856 |
| Enumeration Date | 2020-01-07 |
| Last Update Date | 2020-02-11 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 390200000X | Student in an Organized Health Care Education/Training Program | CA | Student, Health Care |
| Street Address |
3302 RUTHERFORD DR |
| City | STOCKTON |
| State | CA |
| Zip Code | 95212-3425 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962046524 | Randy Sarnillo Morelos | Residential Treatment Facility, Physical Disabilities | 9152 Chianti Circle, Stockton, CA 95212 | 2019-11-06 |
| 1316494339 | Anka Behavioral Health, Inc. | Community/Behavioral Health | 9555 Priscilla Ln, Stockton, CA 95212 | 2016-09-07 |
| 1487058848 | Faith Isiderio | Physical Therapy Assistant | 5650 Patti Lynn Way, Stockton, CA 95212 | 2014-10-14 |
| 1124173448 | George T Lin | Dentist | 3459 Matterhorn Drive, Stockton, CA 95212 | 2007-01-25 |
| 1851395131 | Eric Chapa | Family Medicine | 5040 E Morada Ln, Stockton, CA 95212 | 2005-06-02 |
| 1114530250 | Heather Elizabeth Phillips | Licensed Psychiatric Technician | 4900 N Highway 99 Unit 68, Stockton, CA 95212-1007 | 2020-08-28 |
| 1396281507 | Kaitlend Tatiana Smith | Behavioral Analyst | 4899 Hildreth Ln, Stockton, CA 95212-1408 | 2017-01-11 |
| 1629489315 | Charles Vansicklen | Student in an Organized Health Care Education/Training Program | 8619 Emanuel Way, Stockton, CA 95212-1423 | 2014-05-15 |
| 1891853826 | Raleys | Pharmacy | 4255 E Morada Ln, Stockton, CA 95212-1600 | 2006-12-04 |
| 1881006351 | Phillip H Shin | Pharmacist | 4255 E Morada Ln, Stockton, CA 95212-1600 | 2014-06-02 |
| Find all providers in zip 95212 | ||||
| Taxonomy Code | 390200000X |
| Grouping | Student, Health Care |
| Classification | Student in an Organized Health Care Education/Training Program |
| An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |
| Notes: [1/1/2005: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063021970 | Leslie Jazmin Marin | Student in an Organized Health Care Education/Training Program | 7109 Danny Dr, Stockton, Stockton, CA 95210 | 2020-07-27 |
| 1083223317 | Simone A Stevens | Student in an Organized Health Care Education/Training Program | 2041 Grey Stone Dr, Stockton, CA 95206-4652 | 2020-07-22 |
| 1497381453 | Carrie Elaine Guidry | Student in an Organized Health Care Education/Training Program | 4415 N Pershing Ave Apt 4, Stockton, CA 95207-6955 | 2020-03-20 |
| 1144886375 | Linda Voeuth Kong | Student in an Organized Health Care Education/Training Program | 3830 Alvarado Ave Apt 225, Stockton, CA 95204-2324 | 2019-05-13 |
| 1518439173 | Heidi Lee | Student in an Organized Health Care Education/Training Program | 3591 Quail Lakes Dr Apt 33, Stockton, CA 95207-5253 | 2018-12-20 |
| 1396220331 | Evangelina Dori Olson | Student in an Organized Health Care Education/Training Program | 1803 W March Ln Ste C&d, Stockton, CA 95207-6414 | 2018-09-25 |
| 1548741176 | Diep Phan | Student in an Organized Health Care Education/Training Program | 7720 Lorraine Ave Ste 102, Stockton, CA 95210-4203 | 2018-08-22 |
| 1457885279 | Angud Mehdi | Student in an Organized Health Care Education/Training Program | 6351 Saint Andrews Dr, Stockton, CA 95219-1861 | 2017-04-18 |
| 1477929453 | Manjot Kaur Sandhu | Student in an Organized Health Care Education/Training Program | 5405 N Pershing Ave Ste C1, Stockton, CA 95207-5451 | 2015-08-13 |
| 1740662469 | Maha Abdulla | Student in an Organized Health Care Education/Training Program | 6076 Silveroak Cir, Stockton, CA 95219-7186 | 2015-06-18 |
| 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.