Organization
CENTRAL STOCKTON MEDICAL CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PHILIP A EDINGTON MD (DIRECTOR/OWNER)
(209) 948-5515
Entity
Organization
Contact information
Practice address
1508 WEST LN, STOCKTON, CA 95205-3340
(209) 948-2886
(209) 948-2831
Mailing address
1144 NORMAN DR, SUITE 102, MANTECA, CA 95336-5925
(209) 823-1152
(209) 823-3376
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ZZZ25352Z
GROUP PTAN
CA
Enumeration date
06/05/2006
Last updated
01/04/2008
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