Organization
GOLD COUNTRY HEALTH INITIATIVE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ERNEST VASTI MD (OWNER)
(209) 610-1524
Entity
Organization
Contact information
Practice address
820/830 STATE HIGHWAY 88, JACKSON, CA 95642
(209) 610-1524
Mailing address
PO BOX 4057, STOCKTON, CA 95204-0057
Taxonomy
Speciality
Code
Description
License number
State
207QA0401X
Addiction Medicine (Family Medicine) Physician
Primary
—
—
Other
Enumeration date
03/01/2019
Last updated
12/06/2019
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