CALIFORNIA PRIMARY CARE MEDICAL GROUP, INC. (NPI# 1790910610) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790910610 |
| Entity Type | Organization |
| Organization Name | CALIFORNIA PRIMARY CARE MEDICAL GROUP, INC. |
| Practice Address |
530 W Acacia St Stockton CA 95203-2454 |
| Practice Telephone | 2099445550 |
| Mailing Telephone | 9169445550 |
| Enumeration Date | 2009-05-21 |
| Last Update Date | 2009-05-21 |
| Authorized Official Name | DR. OTASHE NYOKU GOLDEN (MEDICAL DIRECTOR) |
| Authorized Official Telephone | 9168371966 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QP2300X |
Clinic/Center Specialization: Primary Care |
A70035 | CA | Ambulatory Health Care Facilities |
| Y | 261QM1300X |
Clinic/Center Specialization: Multi-Specialty |
Ambulatory Health Care Facilities |
| Street Address |
530 W ACACIA ST |
| City | STOCKTON |
| State | CA |
| Zip Code | 95203-2454 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699195115 | Dameron Hospital Association | Clinic/Center | 530 W Acacia St, Suite 1, Stockton, CA 95203-2454 | 2014-04-23 |
| 1033544325 | Dameron Medical Group, Inc. | Family Medicine | 530 W Acacia St, Stockton, CA 95203-2454 | 2013-09-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447899349 | Sagrario Alva Chavez | Technician | Sagrario Chavez, 1248 West Park St., Stockton, CA 95203 | 2019-12-26 |
| 1538682810 | Kumars Transport | Non-emergency Medical Transport (VAN) | 1112 W Fremont St, Stockton, CA 95203 | 2017-07-19 |
| 1194251595 | Jesmond Ridge Medical Services A Medical Corporation | Emergency Medicine | 525 W Acacla St, Stockton, CA 95203 | 2017-05-04 |
| 1285011064 | Brian Andrew Reuter | Emergency Medicine | Dameron Hospital, 525 Acacia St, Stockton, CA 95203 | 2015-04-30 |
| 1548209240 | Aaron James Simko | Pediatrics | 525 Acacia Street, Neonatal Department, Stockton, CA 95203 | 2006-06-06 |
| 1881057461 | El Concilio | Case Management | 445 N San Joaquin St, Stockton, CA 95203 | 2016-04-01 |
| 1619350634 | Sudha Vani Saduvala | Internal Medicine | 525 W Acacia St, Stockton, CA 95203 | 2015-07-08 |
| 1740621671 | Syed Salman Ali | Internal Medicine | 525 W Acacia St, Stockton, CA 95203 | 2013-07-08 |
| 1417021726 | Sahir Naseer | Emergency Medicine | 525 W Acacia St, Stockton, CA 95203 | 2006-11-20 |
| 1104312800 | Melissa Delossantos | Behavioral Analyst | 2180 Lucerne Ave, Stockton, CA 95203-1257 | 2018-07-05 |
| Find all providers in zip 95203 | ||||
| Taxonomy Code | 261QM1300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Multi-Specialty |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083955801 | County of San Joaquin | Clinic/Center | 1414 N California St Ste A, Stockton, CA 95202-1515 | 2013-03-04 |
| 1538400353 | County of San Joaquin | Clinic/Center | 1414 N California St Ste B, Stockton, CA 95202-1515 | 2013-03-04 |
| 1679023980 | County of San Joaquin | Clinic/Center | 1601 E Hazelton Ave, Stockton, CA 95205-6229 | 2016-10-11 |
| 1891036612 | County of San Joaquin | Clinic/Center | 1414 N California St, Stockton, CA 95202-1515 | 2013-03-04 |
| 1518190958 | Dignity Health Medical Foundation | Clinic/Center | 1901 N California St, Stockton, CA 95204-6005 | 2009-09-02 |
| 1922231422 | Dignity Health Medical Foundation | Clinic/Center | 1901 N California St, Stockton, CA 95204-6005 | 2009-08-31 |
| 1609020569 | Dignity Health Medical Foundation | Clinic/Center | 534 E Pine St, Suite B, Stockton, CA 95204-5536 | 2008-11-05 |
| 1861410581 | Dignity Health Medical Foundation | Clinic/Center | 3132 W March Ln, Suite 5, Stockton, CA 95219-2354 | 2006-07-18 |
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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.