Provider Demographics
NPI:1316190796
Name:SUTTER GOULD MEDICAL FOUNDATION
Entity Type:Organization
Organization Name:SUTTER GOULD MEDICAL FOUNDATION
Other - Org Name:STOCKTON SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:MITNICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-521-6097
Mailing Address - Street 1:8011 DON AVE
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95209
Mailing Address - Country:US
Mailing Address - Phone:209-955-3047
Mailing Address - Fax:209-473-9382
Practice Address - Street 1:8011 DON AVE
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95209
Practice Address - Country:US
Practice Address - Phone:209-955-3047
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUTTER HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-10-29
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical