NPIMap

Organization Active NPI

San Joaquin County CCS

  • Pediatric Physical Therapist
  • Tracy, CA
National Provider Identifier
1689769986
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Physical TherapistTaxonomy code 2251P0200X
Legal business name
SAN JOAQUIN COUNTY CCS
Practice address
1616 Chester Dr
Tracy, CA 95376-2928
Phone
(209) 831-5952
NPI assigned
Oct 3, 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
Dr. Armando Valerio, PT,DPT
Title
MTP Manager
Phone
(209) 953-3617

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Physical TherapistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2251P0200X Primary

Addresses

Primary practice location

1616 Chester Dr
Tracy, CA 95376-2928

Mailing address

PO Box 2009
Stockton, CA 95201-2009
Phone (209) 831-5952

Other identifiers 1

IdentifierTypeStateIssuer
CCS00123FMedicaidCA

Other names 1

  • TRACY MTU Doing business as

National Provider Directory

National Provider Directory
Tax ID family
San Joaquin Gen Hospita94 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

1616 Chester Dr
Tracy, CA 95376
Phone (209) 831-5952

NPI Registry JSON

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

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1689769986",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2009",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952012009",
            "telephone_number": "209-831-5952"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1616 CHESTER DR",
            "city": "TRACY",
            "state": "CA",
            "postal_code": "953762928",
            "telephone_number": "209-831-5952"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN JOAQUIN COUNTY CCS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-03",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "VALERIO",
        "authorized_official_first_name": "ARMANDO",
        "authorized_official_title_or_position": "MTP MANAGER",
        "authorized_official_telephone_number": "209-953-3617",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PT,DPT"
    },
    "taxonomies": [
        {
            "code": "2251P0200X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Therapist, Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "CCS00123F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "TRACY MTU",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tracy, 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.