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Organization
SUTTER GOULD MEDICAL FOUNDATION
Active
Organization
SUTTER GOULD MEDICAL FOUNDATION
Active
Other names
Stockton Medical Plaza Primary Care
Organization subpart
No
Provider details
NPI number
Authorized official
STEVEN A MITNICK MD (MEDICAL DIRECTOR)
(209) 521-6097
Entity
Organization
Contact information
Practice address
2505 W HAMMER LN, STOCKTON, CA 95209-2839
(209) 957-7050
Mailing address
600 COFFEE RD, MODESTO, CA 95355-4201
(209) 524-1211
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
G32207
CA
207R00000X
Internal Medicine Physician
G25105
CA
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
G41310
CA
208000000X
Pediatrics Physician
A16204
CA
Other
Enumeration date
07/05/2006
Last updated
10/03/2012
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