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Organization
GERIATRICS LONG TERM CARE MEDICAL CORPORATION
Active
Organization
GERIATRICS LONG TERM CARE MEDICAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BAO QUY NGUYEN M.D. (OWNER)
(909) 659-3707
Entity
Organization
Contact information
Practice address
1240 ROBINHOOD DRIVE, SUITE A, STOCKTON, CA 95207-5507
(209) 475-8144
(209) 474-7679
Mailing address
PO BOX 7304, STOCKTON, CA 95267-0304
(909) 659-3509
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
A927250
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A927250
—
CA
01
—
A927250
PHYSICIAN AND SURGEON LICENSE
CA
Enumeration date
08/25/2009
Last updated
11/23/2011
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