County of San Joaquin

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

License

030000087 Issued in CA

Legal business name

COUNTY OF SAN JOAQUIN

Practice address

1601 E Hazelton Ave
Stockton, CA 95205-6229

Phone

(209) 468-6937

Fax

(209) 468-7042

NPI assigned

Oct 11, 2016

Organization subpart

Yes

Parent organization

COUNTY OF SAN JOAQUINAs reported in NPPES

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

Authorized official

Name

Mr. David B Jomaoas

Title

Director of Ambulatory Care Service

Phone

(209) 468-6160

Specialties & licenses 1

Addresses

Other names 1

• San Joaquin County Clinic Hazelton Doing business as

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

CLIA laboratory certificates

Part of

San Joaquin Gen Hospita

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

{
    "created_epoch": "1476144000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1622592000000",
    "number": "1679023980",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1020",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952013120",
            "telephone_number": "209-468-6937",
            "fax_number": "209-468-7042"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1601 E HAZELTON AVE",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952056229",
            "telephone_number": "209-468-6937",
            "fax_number": "209-468-7042"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTY OF SAN JOAQUIN",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COUNTY OF SAN JOAQUIN",
        "enumeration_date": "2016-10-11",
        "last_updated": "2021-06-02",
        "certification_date": "2021-06-02",
        "status": "A",
        "authorized_official_last_name": "JOMAOAS",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "DIRECTOR OF AMBULATORY CARE SERVICE",
        "authorized_official_telephone_number": "209-468-6160",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "CA",
            "license": "030000087",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "San Joaquin County Clinic Hazelton",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Madison Annelise Coty
• Ashlyn Brooke Couillard
• Country Palms Care Home
• County of San Joaquin
• County of San Joaquin
• County of San Joaquin
• County of San Joaquin
• Maria Dejesus Covarrubias-Gamino
• Mario Covarrubias
• Covenant Care California, LLC

• Multi-Specialty Clinic/Center in Stockton, CA
• Providers in Stockton, CA by specialty
• Multi-Specialty Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• 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.