San Joaquin Laser and Surgery Center

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

030000469 Issued in CA

Legal business name

SAN JOAQUIN LASER AND SURGERY CENTER

Practice address

1805 N California St Ste 101a
Stockton, CA 95204-6032

Phone

(209) 948-5515

NPI assigned

Jul 9, 2006

Organization subpart

No

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

Authorized official

Name

Janee Tavares

Title

Adminstrator

Phone

(209) 948-3241

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• San Joaquin Laser & Surgery Center Other name

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Listed as

San Joaquin Laser and Surgery Center IncCCN 05C0001077

Medicare certification status

ActiveFrom the Provider of Services file

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.

• San Joaquin Laser Surgery Center

  • Ambulatory Surgical Clinic/Center
  • Stockton, CA
  • NPI 1639183486
  NPD tax ID

Locations

Practitioners 1

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

• Andrew Philip Chen, M.D.

  • Ophthalmology Physician
  • Lodi, CA
  • NPI 1912014739
  NPD

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

{
    "created_epoch": "1152403200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1740614400000",
    "number": "1730112178",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1805 N CALIFORNIA ST STE 101A",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952046032",
            "telephone_number": "209-948-3241",
            "fax_number": "209-948-8009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1805 N CALIFORNIA ST STE 101A",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952046032",
            "telephone_number": "209-948-5515"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN JOAQUIN LASER AND SURGERY CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-09",
        "last_updated": "2025-02-27",
        "certification_date": "2025-02-27",
        "status": "A",
        "authorized_official_last_name": "TAVARES",
        "authorized_official_first_name": "JANEE",
        "authorized_official_title_or_position": "ADMINSTRATOR",
        "authorized_official_telephone_number": "209-948-3241"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "CA",
            "license": "030000469",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP PTAN",
            "identifier": "ZZZ17148Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "San Joaquin Laser & Surgery Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• San Joaquin Hearing
• San Joaquin Hematology Oncology
• San Joaquin Hematology Oncology a PC
• San Joaquin Hematology/Oncology a Professional Corp
• San Joaquin Kidney Clinic, Inc
• San Joaquin Laser Surgery Center
• San Joaquin Orthotics & Prosthetics
• San Joaquin PCCM Professional Corporation
• San Joquin County Mental Health Services
• San Luis Physical Therapy & Orthopedic Rehabilitation Inc

• Ambulatory Surgical Clinic/Center in Stockton, CA
• Providers in Stockton, CA by specialty
• Ambulatory Surgical Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2025; 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.