| Cmc, Lodi Vine Pediatrics, Suite 100 | |
|
2415 W Vine St Ste 100 Lodi CA 95242-3731 | |
| (209) 333-3135 | |
| Not Available |
| Full Name | Cmc, Lodi Vine Pediatrics, Suite 100 |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 2415 W Vine St Ste 100, Lodi, California |
| Authorized Official Name and Position | Christine Noguera (CEO) |
| Authorized Official Contact | 2093732831 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Cmc, Lodi Vine Pediatrics, Suite 100 7210 Murray Dr Stockton CA 95210-3339 Ph: (209) 373-2800 | Cmc, Lodi Vine Pediatrics, Suite 100 2415 W Vine St Ste 100 Lodi CA 95242-3731 Ph: (209) 333-3135 |
| NPI Number | 1710542816 |
|---|---|
| Provider Enumeration Date | 05/03/2019 |
| Last Update Date | 07/05/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710542816 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (NU) | Primary |
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Cmc, Lodi Vine Family Care, Suite 105 Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2415 W Vine St Ste 105, Lodi, CA 95242 Phone: 209-333-3121 |
Fairmont Ave Care Center Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 999 S Fairmont Ave, #130/135, Lodi, CA 95240 Phone: 209-366-2001 |
Lodi Memorial Urgent Care Clinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1235 W Vine St Ste 20, Lodi, CA 95240 Phone: 209-339-7625 Fax: 209-339-7659 |