Provider Demographics
NPI:1598200263
Name:FATHERS & FAMILIES OF SAN JOAQUIN
Entity Type:Organization
Organization Name:FATHERS & FAMILIES OF SAN JOAQUIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:NUNEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-941-0701
Mailing Address - Street 1:338 E MARKET ST
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95202-3210
Mailing Address - Country:US
Mailing Address - Phone:209-941-0701
Mailing Address - Fax:209-941-0784
Practice Address - Street 1:338 E MARKET ST
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95202-3210
Practice Address - Country:US
Practice Address - Phone:209-941-0701
Practice Address - Fax:209-941-0784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-04
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1700115721251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health