Organization
SAN JOAQUIN CARDIOLOGY MEDICAL GROUP INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. PATTY S BALDERSTON (ADMINISTRATOR)
(209) 942-1005
Entity
Organization
Contact information
Practice address
2800 N CALIFORNIA ST STE 14, STOCKTON, CA 95204-3759
(209) 942-1005
(209) 942-0455
Mailing address
2800 N CALIFORNIA ST, SUITE 14, STOCKTON, CA 95204
(209) 942-1005
(209) 942-0455
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CC6353
RAILROAD MEDICARE
CA
05
—
GR0062380
—
CA
Enumeration date
07/04/2006
Last updated
01/11/2011
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