Individual provider Active NPI

Victoria G. Formoso, M.D.

  • Internal Medicine Physician
  • French Camp, CA
National Provider Identifier
1679591861
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
A039645 Issued in CA
Practice address
500 W. Hospital Rd.
French Camp, CA 95231
Phone
(209) 468-6937
Fax
(209) 468-7042
NPI assigned
Jul 17, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X A039645 CA Primary

Addresses

Primary practice location

500 W. Hospital Rd.
French Camp, CA 95231

Mailing address

PO Box 1020
Stockton, CA 95201-3120
Phone (209) 468-6937

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110316000664 CA Practitioner - Internal Medicine 6901088632 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A039645CAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
County of San Joaquin CurrentSince Oct 4, 1994 Accepting new patients
County of San Joaquin CurrentSince Oct 4, 1994 Accepting new patients

Locations

500 W Hospital Rd
French Camp, CA 95231
Phone (209) 468-6000

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1153094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1679591861",
    "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": "500 W. HOSPITAL RD.",
            "city": "FRENCH CAMP",
            "state": "CA",
            "postal_code": "95231",
            "telephone_number": "209-468-6937",
            "fax_number": "209-468-7042"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORMOSO",
        "first_name": "VICTORIA",
        "middle_name": "G.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-17",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A039645",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in French Camp, CA

Sources for this page

Verify at the official NPI Registry.