| |
1335 S Fairmont Ave Lodi CA 95240-5520 | |
(209) 366-2007 | |
Not Available |
Full Name | |
---|---|
Speciality | Family Medicine |
Location | 1335 S Fairmont Ave, Lodi, California |
Authorized Official Name and Position | Steven A Mitnick (MEDICAL DIRECTOR) |
Authorized Official Contact | 2095216097 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
600 Coffee Rd Modesto CA 95355-4201 Ph: (209) 524-1211 | 1335 S Fairmont Ave Lodi CA 95240-5520 Ph: (209) 366-2007 |
NPI Number | 1982648580 |
---|---|
Provider Enumeration Date | 06/15/2006 |
Last Update Date | 05/06/2010 |
Identifier | Type | State | Issuer |
---|---|---|---|
1982648580 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |
Inpatient Services Of California, Inc., A Medical Corporation Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 975 S. Fairmont Ave, Lodi, CA 95240 Phone: 214-712-2400 |