Provider Demographics
NPI:1356453831
Name:SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES
Entity Type:Organization
Organization Name:SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC PROGRAM COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CHARLOTTE
Authorized Official - Middle Name:V
Authorized Official - Last Name:HUNTER-BROWH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-468-8934
Mailing Address - Street 1:1601 E HAZELTON AVE
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95205-6229
Mailing Address - Country:US
Mailing Address - Phone:209-468-8934
Mailing Address - Fax:209-468-2072
Practice Address - Street 1:1601 E HAZELTON AVE
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95205-6229
Practice Address - Country:US
Practice Address - Phone:209-468-8934
Practice Address - Fax:209-468-2072
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAN JOAQUIN COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-31
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare