1932255577 NPI number — SAN JOAQUIN COUNTY OFFICE OF EDUCATION

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932255577 NPI number — SAN JOAQUIN COUNTY OFFICE OF EDUCATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAN JOAQUIN COUNTY OFFICE OF EDUCATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1932255577
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/08/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 213030
Provider Second Line Business Mailing Address:
2901 ARCH-AIRPORT ROAD
Provider Business Mailing Address City Name:
STOCKTON
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95213-9030
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
209-468-4960
Provider Business Mailing Address Fax Number:
209-468-4955

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2707 TRANSWORLD DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STOCKTON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95206-3948
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-468-4960
Provider Business Practice Location Address Fax Number:
209-468-4955
Provider Enumeration Date:
01/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FOUNTS
Authorized Official First Name:
MICK
Authorized Official Middle Name:
WILLIAM
Authorized Official Title or Position:
SAN JOAQUIN COUNTY SUPERINTENDENT O
Authorized Official Telephone Number:
209-468-4802

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251300000X , with the licence number: SS3910397 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: SS3910397 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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