Provider Demographics
NPI:1649393216
Name:JORI ANDRUS
Entity Type:Organization
Organization Name:JORI ANDRUS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GRADUATE COORDINATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:JORI
Authorized Official - Middle Name:ANDRUS
Authorized Official - Last Name:LEIGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-663-7734
Mailing Address - Street 1:19818 N GOLF CLUB RD
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:95258-9246
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3601 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95211-0110
Practice Address - Country:US
Practice Address - Phone:209-946-2132
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization