Organization
SAN JOAQUIN LASER AND SURGERY CENTER
Active
Other names
San Joaquin Laser & Surgery Center
Organization subpart
No
Provider details
NPI number
Authorized official
JANEE TAVARES (ADMINSTRATOR)
(209) 948-3241
Entity
Organization
Contact information
Practice address
1805 N CALIFORNIA ST STE 101A, STOCKTON, CA 95204-6032
(209) 948-5515
Mailing address
1805 N CALIFORNIA ST STE 101A, STOCKTON, CA 95204-6032
(209) 948-3241
(209) 948-8009
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
030000469
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ZZZ17148Z
GROUP PTAN
CA
Enumeration date
07/09/2006
Last updated
02/27/2025
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