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Organization
MANTECA MEDICAL GROUP, INC
Active
Organization
MANTECA MEDICAL GROUP, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TERRY CROASDALE M.D. (CFO/COO)
(209) 823-7646
Entity
Organization
Contact information
Practice address
1262 E NORTH ST, MANTECA, CA 95336-4962
(209) 823-7646
(209) 824-5374
Mailing address
1262 E NORTH ST, MANTECA, CA 95336-4962
(209) 823-7646
(209) 824-5374
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
A24460
CA
207R00000X
Internal Medicine Physician
A54203
CA
207R00000X
Internal Medicine Physician
Primary
C43012
CA
207V00000X
Obstetrics & Gynecology Physician
20A7379
CA
207V00000X
Obstetrics & Gynecology Physician
G55402
CA
208000000X
Pediatrics Physician
A50060
CA
208000000X
Pediatrics Physician
A51139
CA
Other
Enumeration date
04/12/2006
Last updated
04/09/2010
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