Provider Demographics
NPI:1851384911
Name:PEDIATRIC ASSOCIATES OF STOCKTON
Entity Type:Organization
Organization Name:PEDIATRIC ASSOCIATES OF STOCKTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUE
Authorized Official - Middle Name:
Authorized Official - Last Name:ZUMWALT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-870-2724
Mailing Address - Street 1:89 W MARCH LN
Mailing Address - Street 2:SUITE #1
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-5723
Mailing Address - Country:US
Mailing Address - Phone:209-478-2622
Mailing Address - Fax:209-870-2754
Practice Address - Street 1:89 W MARCH LN
Practice Address - Street 2:SUITE #1
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-5723
Practice Address - Country:US
Practice Address - Phone:209-478-2622
Practice Address - Fax:209-870-2754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ557612OtherBLUE CROSS