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Organization
MEDCORE HP
Active
Organization
MEDCORE HP
Active
Parent organization
OMNI IPA MEDICAL GROUP, INC.
Organization subpart
Yes
Provider details
NPI number
Legal business name
OMNI IPA MEDICAL GROUP, INC.
Authorized official
MRS. MARIA TERESA MARTINEZ (CHIEF OPERATIONS OFFICER)
(209) 320-2631
Entity
Organization
Contact information
Practice address
2701 E HAMMER LN, SUITE 103, STOCKTON, CA 95210-4245
(209) 320-2631
(209) 320-2653
Mailing address
2609 E HAMMER LANE, STOCKTON, CA 95210
(209) 320-2631
(209) 320-2653
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Enumeration date
03/21/2017
Last updated
03/21/2017
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