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Organization
SUTTER GOULD MEDICAL FOUNDATION
Active
Organization
SUTTER GOULD MEDICAL FOUNDATION
Active
Other names
Brookside Care Center
Organization subpart
No
Provider details
NPI number
Authorized official
STEVEN A MITNICK MD (MEDICAL DIRECTOR)
(209) 521-6097
Entity
Organization
Contact information
Practice address
3132 W MARCH LN, STOCKTON, CA 95219-2354
(209) 954-3370
Mailing address
600 COFFEE RD, MODESTO, CA 95355-4201
(209) 524-1211
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0005874
—
CA
Enumeration date
05/26/2006
Last updated
08/22/2020
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