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Organization
WESTLANE MEDICAL CLINIC,INC
Active
Organization
WESTLANE MEDICAL CLINIC,INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GABRIEL KODZO TANSON M.D. (MEDICAL DIRECTOR)
(209) 472-1515
Entity
Organization
Contact information
Practice address
4873 WEST LN, SUITE A, STOCKTON, CA 95210-4548
(209) 472-1515
(209) 472-1651
Mailing address
4873 WEST LN, SUITE A, STOCKTON, CA 95210-4548
(209) 472-1515
(209) 472-1651
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
A325500
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A325500
—
CA
Enumeration date
01/24/2007
Last updated
03/03/2021
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