Organization
DELTA HEART & MEDICAL CLINIC, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BUNMI OLOWOYEYE (ADMINISTRATOR)
(209) 951-9884
Entity
Organization
Contact information
Practice address
1801 E MARCH LN, A-170, STOCKTON, CA 95210-6629
(209) 951-9884
(209) 951-7873
Mailing address
1801 E MARCH LN, A-170, STOCKTON, CA 95210-6629
(209) 951-9884
(209) 951-7873
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
A48005
CA
207RI0011X
Interventional Cardiology Physician
Primary
A48005
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A480050
—
CA
01
—
037196
HILL PHYSICIANS MED GROUP
CA
05
—
6923038
—
CA
01
—
DC3822
RAILROAD MEDICARE PIN
—
01
—
OOA480050
PTAN
—
01
—
ZZZ64420Z
BLUE SHIELD OF CA
CA
Enumeration date
04/06/2007
Last updated
10/29/2008
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