| Geriatrics Long Term Care Medical Corporation | |
|
1240 Robinhood Drive Suite A Stockton CA 95207-5507 | |
| (209) 475-8144 | |
| (209) 474-7679 |
| Full Name | Geriatrics Long Term Care Medical Corporation |
|---|---|
| Speciality | Internal Medicine |
| Location | 1240 Robinhood Drive, Stockton, California |
| Authorized Official Name and Position | Bao Quy Nguyen (OWNER) |
| Authorized Official Contact | 9096593707 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Geriatrics Long Term Care Medical Corporation Po Box 7304 Stockton CA 95267-0304 Ph: (909) 659-3509 | Geriatrics Long Term Care Medical Corporation 1240 Robinhood Drive Suite A Stockton CA 95207-5507 Ph: (209) 475-8144 |
| NPI Number | 1952534927 |
|---|---|
| Provider Enumeration Date | 08/25/2009 |
| Last Update Date | 11/23/2011 |
| Medicare PECOS PAC ID | 0042402042 |
|---|---|
| Medicare Enrollment ID | O20101008000701 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952534927 | NPI | - | NPPES |
| A927250 | Other | CA | PHYSICIAN AND SURGEON LICENSE |
| 00A927250 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | A927250 (California) | Primary |
| Provider Name | Vincent Chi-wing Lo |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1275640864 PECOS PAC ID: 6204857022 Enrollment ID: I20051208000369 |
| Provider Name | Bao Quy Nguyen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1821032475 PECOS PAC ID: 6800802646 Enrollment ID: I20060302000389 |
| Provider Name | Jun G Paz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326322264 PECOS PAC ID: 0244494680 Enrollment ID: I20120614000302 |
| Provider Name | Roy Blanco |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417074907 PECOS PAC ID: 8628292075 Enrollment ID: I20150908002681 |
| Provider Name | Dolly Luong |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992082903 PECOS PAC ID: 8729398763 Enrollment ID: I20221029000230 |
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San Joaquin County Clinics Chs Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1414 N California St Suite A, Stockton, CA 95202 Phone: 209-953-6400 Fax: 209-468-2321 | |
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