Basic Information
| Provider Information | |||||||||
| NPI: | 1144364621 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ASPIRANET | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6 S EL DORADO ST | ||||||||
| Address2: | SUITE 510 | ||||||||
| City: | STOCKTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 952022804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2094789862 | ||||||||
| FaxNumber: | 2094781938 | ||||||||
| Practice Location | |||||||||
| Address1: | 2423 W MARCH LN STE 200 | ||||||||
| Address2: | |||||||||
| City: | STOCKTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 952078250 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2094789862 | ||||||||
| FaxNumber: | 2094781938 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/16/2007 | ||||||||
| LastUpdateDate: | 06/13/2022 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | BROWN | ||||||||
| AuthorizedOfficialFirstName: | VERNON | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF EXECUTIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 6508664080 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | ASPIRANET | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 06/13/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | 397000134 | CA | Y | Agencies | Community/Behavioral Health |
No ID Information.