San Joaquin Orthotics & Prosthetics

Primary specialty

Prosthetic/Orthotic SupplierTaxonomy code 335E00000X

License

07-00072230 Issued in CA

Legal business name

SAN JOAQUIN ORTHOTICS & PROSTHETICS

Practice address

2211 N California St
Stockton, CA 95204-5503

Phone

(209) 932-0170

Fax

(209) 932-0172

NPI assigned

Jul 20, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Matthew Shane Evans, CPONPI 1245476597

Title

Business Owner/Manager

Phone

(209) 932-0170

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Locations

Practitioners 1

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

• Matthew Shane Evans, CPO

  • Prosthetist
  • Modesto, CA
  • NPI 1245476597

  Orthotist

  NPD Authorized official

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

{
    "created_epoch": "1153353600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1442275200000",
    "number": "1649290107",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2211 N CALIFORNIA ST",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952045503",
            "telephone_number": "209-932-0170",
            "fax_number": "209-932-0172"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2211 N CALIFORNIA ST",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952045503",
            "telephone_number": "209-932-0170",
            "fax_number": "209-932-0172"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN JOAQUIN ORTHOTICS & PROSTHETICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-20",
        "last_updated": "2015-09-15",
        "status": "A",
        "authorized_official_last_name": "EVANS",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "SHANE",
        "authorized_official_title_or_position": "BUSINESS OWNER/MANAGER",
        "authorized_official_telephone_number": "209-932-0170",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CPO"
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": "CA",
            "license": "07-00072230",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "ZZZ07247Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• San Joaquin Laser and Surgery Center
• San Joaquin Laser Surgery Center
• San Joaquin PCCM Professional Corporation
• San Joquin County Mental Health Services
• San Luis Physical Therapy & Orthopedic Rehabilitation Inc
• Monique San
• Sophie San

• Prosthetic/Orthotic Supplier in Stockton, CA
• Providers in Stockton, CA by specialty
• Prosthetic/Orthotic Supplier in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.