Stockton Pediatric Med. Group, Inc.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

0700081405 Issued in CA

Legal business name

STOCKTON PEDIATRIC MED. GROUP, INC.

Practice address

2349 N California St
Stockton, CA 95204-5505

Phone

(209) 469-2229

Fax

(209) 466-2436

NPI assigned

Jul 22, 2006

Organization subpart

No

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

Authorized official

Name

Jan Oliveira

Title

Administrator

Phone

(209) 469-2229

Specialties & licenses 1

Addresses

Other names 1

• Stockton Pediatrics Other name

Locations

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

{
    "created_epoch": "1153526400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1238716800000",
    "number": "1811918931",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2349 N CALIFORNIA ST",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952045505",
            "telephone_number": "209-469-2229",
            "fax_number": "209-466-2436"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2349 N CALIFORNIA ST",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952045505",
            "telephone_number": "209-469-2229",
            "fax_number": "209-466-2436"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STOCKTON PEDIATRIC MED. GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-22",
        "last_updated": "2009-04-03",
        "status": "A",
        "authorized_official_last_name": "OLIVEIRA",
        "authorized_official_first_name": "JAN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "209-469-2229"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "0700081405",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Stockton Pediatrics",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Stockton Outpatient Surgery Center LLC (Ambulatory Surgery Center of Stockton)
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• Stockton Pathology Medical Group (Stockton Pathology Medical Group Laboratory)
• Stockton Pathology Medical Group
• Stockton Pharmacy
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• Stockton Physical Therapy and Lymphedema Clinic, Inc
• Stockton Pregnancy Control Medical Clinic
• Stockton Regional Rehabilitation Hospital LLC (Stockton Regional Rehabilitation Hospital)

• Pediatrics Physician in Stockton, CA
• Providers in Stockton, CA by specialty
• Pediatrics Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2009; 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.