| Westlane Medical Clinic,inc | |
|
4873 West Ln Suite A Stockton CA 95210-4548 | |
| (209) 472-1515 | |
| (209) 472-1651 |
| Full Name | Westlane Medical Clinic,inc |
|---|---|
| Speciality | Family Medicine |
| Location | 4873 West Ln, Stockton, California |
| Authorized Official Name and Position | Gabriel Kodzo Tanson (MEDICAL DIRECTOR) |
| Authorized Official Contact | 2094721515 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Westlane Medical Clinic,inc 4873 West Ln Suite A Stockton CA 95210-4548 Ph: (209) 472-1515 | Westlane Medical Clinic,inc 4873 West Ln Suite A Stockton CA 95210-4548 Ph: (209) 472-1515 |
| NPI Number | 1689729352 |
|---|---|
| Provider Enumeration Date | 01/24/2007 |
| Last Update Date | 03/03/2021 |
| Medicare PECOS PAC ID | 4789651613 |
|---|---|
| Medicare Enrollment ID | O20040910001229 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689729352 | NPI | - | NPPES |
| 00A325500 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | A325500 (California) | Primary |
| Provider Name | Elvis Akpene Tanson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1720136138 PECOS PAC ID: 7517953763 Enrollment ID: I20040422000988 |
| Provider Name | Gabriel Tanson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1023053105 PECOS PAC ID: 0143297077 Enrollment ID: I20040913000569 |
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