1710279781 NPI number — MR. JOHN GABRIEL SISNEROZ M.S.

Table of content: MR. JOHN GABRIEL SISNEROZ M.S. (NPI 1710279781)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710279781 NPI number — MR. JOHN GABRIEL SISNEROZ M.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SISNEROZ
Provider First Name:
JOHN
Provider Middle Name:
GABRIEL
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
M.S.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1710279781
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/19/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10100 TRINITY PKWY STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STOCKTON
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95219-7239
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
209-953-3741
Provider Business Mailing Address Fax Number:
209-953-9199

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 W. HOSPITAL ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRENCH CAMP
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95231-3809
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-953-3741
Provider Business Practice Location Address Fax Number:
209-953-9199
Provider Enumeration Date:
05/10/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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