Provider Demographics
NPI:1316412372
Name:STOCKTON VITALITY, LLC
Entity Type:Organization
Organization Name:STOCKTON VITALITY, LLC
Other - Org Name:SAUCEDA URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:LOU
Authorized Official - Last Name:SAUCEDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-430-0720
Mailing Address - Street 1:107 S MAIN ST STE B
Mailing Address - Street 2:
Mailing Address - City:FORT STOCKTON
Mailing Address - State:TX
Mailing Address - Zip Code:79735-6807
Mailing Address - Country:US
Mailing Address - Phone:432-360-3029
Mailing Address - Fax:855-893-1617
Practice Address - Street 1:703 N MAIN ST
Practice Address - Street 2:
Practice Address - City:FORT STOCKTON
Practice Address - State:TX
Practice Address - Zip Code:79735-5627
Practice Address - Country:US
Practice Address - Phone:432-360-3029
Practice Address - Fax:855-893-1617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-05
Last Update Date:2018-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care