Provider Demographics
NPI:1538696141
Name:SAN JOAQUIN GENERAL
Entity Type:Organization
Organization Name:SAN JOAQUIN GENERAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR OFFICE ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:YVONNE
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-468-6210
Mailing Address - Street 1:500 W HOSPITAL ROAD
Mailing Address - Street 2:
Mailing Address - City:FRENCH CAMP
Mailing Address - State:CA
Mailing Address - Zip Code:95231
Mailing Address - Country:US
Mailing Address - Phone:209-468-6000
Mailing Address - Fax:
Practice Address - Street 1:500 W HOSPITAL ROAD
Practice Address - Street 2:
Practice Address - City:FRENCH CAMP
Practice Address - State:CA
Practice Address - Zip Code:95231
Practice Address - Country:US
Practice Address - Phone:209-468-6000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-12
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital