NPIMap

Organization Active NPI

San Joaquin Laser Surgery Center

  • Ambulatory Surgical Clinic/Center
  • Stockton, CA
National Provider Identifier
1639183486
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
License
30000469 Issued in CA
Legal business name
SAN JOAQUIN LASER SURGERY CENTER
Practice address
1805 N California St
Suite 101 a
Stockton, CA 95204-6037
Phone
(209) 948-3241
Fax
(209) 948-9321
NPI assigned
Jul 28, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Philip A Edington, MD
Title
Director
Phone
(209) 948-5515

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X 30000469 CA Primary

Addresses

Primary practice location

1805 N California St
Suite 101 a
Stockton, CA 95204-6037

Mailing address

1805 N California St
Suite 101 a
Stockton, CA 95204-6037
Phone (209) 948-3241

National Provider Directory

National Provider Directory
Tax ID family
San Joaquin Laser and SC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154044800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1639183486",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1805 N CALIFORNIA ST",
            "address_2": "SUITE 101 A",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952046037",
            "telephone_number": "209-948-3241",
            "fax_number": "209-948-9321"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1805 N CALIFORNIA ST",
            "address_2": "SUITE 101 A",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952046037",
            "telephone_number": "209-948-3241",
            "fax_number": "209-948-9321"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN JOAQUIN LASER SURGERY CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-28",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "EDINGTON",
        "authorized_official_first_name": "PHILIP",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "209-948-5515",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "CA",
            "license": "30000469",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Stockton, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.