Basic Information
| Provider Information | |||||||||
| NPI: | 1134654684 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SAN JOAQUIN GENERAL HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 108 DUTTON AVE | ||||||||
| Address2: | |||||||||
| City: | SAN LEANDRO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945772841 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5107354044 | ||||||||
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| Practice Location | |||||||||
| Address1: | 500 W HOSPITAL RD | ||||||||
| Address2: | |||||||||
| City: | FRENCH CAMP | ||||||||
| State: | CA | ||||||||
| PostalCode: | 952319693 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2094686000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/21/2017 | ||||||||
| LastUpdateDate: | 04/21/2017 | ||||||||
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| AuthorizedOfficialLastName: | WOOTEN | ||||||||
| AuthorizedOfficialFirstName: | ROB | ||||||||
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| AuthorizedOfficialTitleorPosition: | SJGH FOUNDATION EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 2094687781 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 04003 | CA | Y | Hospitals | General Acute Care Hospital |
No ID Information.