Provider Demographics
NPI:1982823878
Name:SANGER WALK-IN CLINIC & WELLNESS CENTER
Entity Type:Organization
Organization Name:SANGER WALK-IN CLINIC & WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:I
Authorized Official - Last Name:IDONI
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:559-876-6070
Mailing Address - Street 1:2535 JENSEN AVE
Mailing Address - Street 2:
Mailing Address - City:SANGER
Mailing Address - State:CA
Mailing Address - Zip Code:93657-2288
Mailing Address - Country:US
Mailing Address - Phone:559-876-6070
Mailing Address - Fax:559-876-6078
Practice Address - Street 1:2535 JENSEN AVE
Practice Address - Street 2:
Practice Address - City:SANGER
Practice Address - State:CA
Practice Address - Zip Code:93657-2288
Practice Address - Country:US
Practice Address - Phone:559-876-6070
Practice Address - Fax:559-876-6078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG12981207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ04986ZOtherMEDICARE GROUP #