Provider Demographics
NPI:1407917354
Name:I. CHRISTOPHER HUDLIN JR., MD, A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:I. CHRISTOPHER HUDLIN JR., MD, A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CELESTE
Authorized Official - Middle Name:
Authorized Official - Last Name:GARDEA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-941-0127
Mailing Address - Street 1:1805 N CALIFORNIA ST
Mailing Address - Street 2:SUITE 310
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95204-6037
Mailing Address - Country:US
Mailing Address - Phone:209-941-0127
Mailing Address - Fax:209-941-0155
Practice Address - Street 1:1805 N CALIFORNIA ST
Practice Address - Street 2:SUITE 310
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95204-6037
Practice Address - Country:US
Practice Address - Phone:209-941-0127
Practice Address - Fax:209-941-0155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG50057208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G500570Medicaid
CA00G500570Medicare ID - Type Unspecified
CA00G500570Medicaid