Provider Demographics
NPI:1710279781
Name:SISNEROZ, JOHN GABRIEL (MS)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:GABRIEL
Last Name:SISNEROZ
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:10100 TRINITY PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95219-7239
Mailing Address - Country:US
Mailing Address - Phone:209-953-3741
Mailing Address - Fax:209-953-9199
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:95231-3809
Practice Address - Country:US
Practice Address - Phone:209-953-3741
Practice Address - Fax:209-953-9199
Is Sole Proprietor?:No
Enumeration Date:2011-05-10
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator