# SUTTER GOULD MEDICAL FOUNDATION

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Stockton Medical Plaza Specialty Care
- **Organization subpart:** No

## Provider details

- **NPI number:** 1477593176
- **Authorized official:** STEVEN A MITNICK MD (MEDICAL DIRECTOR)
- **Authorized official phone:** (209) 521-6097

## Contact information

- **Practice address:** 2545 W HAMMER LN, STOCKTON, CA 95209-2839
- **Practice address phone:** (209) 957-7050
- **Mailing address:** 600 COFFEE RD, MODESTO, CA 95355-4201
- **Mailing address phone:** (209) 524-1211

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207N00000X | Dermatology Physician | — | NULL | — |
| 207N00000X | Dermatology Physician | — | — | — |
| 207P00000X | Emergency Medicine Physician | — | NULL | — |
| 207P00000X | Emergency Medicine Physician | — | — | — |
| 207V00000X | Obstetrics & Gynecology Physician | — | NULL | — |
| 207V00000X | Obstetrics & Gynecology Physician | — | — | — |
| 207X00000X | Orthopaedic Surgery Physician | — | NULL | Yes |
| 207X00000X | Orthopaedic Surgery Physician | — | — | Yes |
| 208600000X | Surgery Physician | — | NULL | — |
| 208600000X | Surgery Physician | — | — | — |
| 208800000X | Urology Physician | — | NULL | — |
| 208800000X | Urology Physician | — | — | — |

## Other

- **Enumeration date:** 06/08/2006
- **Last updated:** 03/19/2010