Provider Demographics
NPI:1841870425
Name:SAN JOAQUIN COUNTY CLINICS
Entity type:Organization
Organization Name:SAN JOAQUIN COUNTY CLINICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:MS
Authorized Official - First Name:CHERON
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBINSON RICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-468-6160
Mailing Address - Street 1:500 W HOSPITAL RD STE A
Mailing Address - Street 2:
Mailing Address - City:FRENCH CAMP
Mailing Address - State:CA
Mailing Address - Zip Code:95231-9693
Mailing Address - Country:US
Mailing Address - Phone:209-468-6160
Mailing Address - Fax:
Practice Address - Street 1:500 W HOSPITAL RD STE A
Practice Address - Street 2:
Practice Address - City:FRENCH CAMP
Practice Address - State:CA
Practice Address - Zip Code:95231-9693
Practice Address - Country:US
Practice Address - Phone:209-468-6820
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-08
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA8415340Medicaid
CA4405340Medicaid
CA0814940Medicaid
CA5475340Medicaid
CA3425340Medicaid
CA5565340Medicaid