Organization
PINNACLE SJIR
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID SOTO (MEDICAL DIRECTOR)
(209) 788-8180
Entity
Organization
Contact information
Practice address
145 TREVINO AVE, MANTECA, CA 95337-4200
(209) 788-8180
(209) 783-0036
Mailing address
145 TREVINO AVE, MANTECA, CA 95337-4200
(209) 756-4832
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2085R0202X
TAXONOMY
—
Enumeration date
08/15/2019
Last updated
12/22/2021
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