# SAN JOAQUIN LASER AND SURGERY CENTER

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- **Entity:** Organization
- **Status:** Active
- **Other names:** San Joaquin Laser & Surgery Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1730112178
- **Authorized official:** JANEE TAVARES (ADMINSTRATOR)
- **Authorized official phone:** (209) 948-3241

## Contact information

- **Practice address:** 1805 N CALIFORNIA ST STE 101A, STOCKTON, CA 95204-6032
- **Practice address phone:** (209) 948-5515
- **Mailing address:** 1805 N CALIFORNIA ST STE 101A, STOCKTON, CA 95204-6032
- **Mailing address phone:** (209) 948-3241
- **Mailing address fax:** (209) 948-8009

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | 030000469 | CA | Yes |

## Other

- **Enumeration date:** 07/09/2006
- **Last updated:** 02/27/2025