Provider Demographics
NPI:1427510627
Name:STOCKTON SLEEP CENTER INC
Entity type:Organization
Organization Name:STOCKTON SLEEP CENTER INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAGSHAMAS
Authorized Official - Middle Name:S
Authorized Official - Last Name:BAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-957-1244
Mailing Address - Street 1:1545 SAINT MARKS PLAZA
Mailing Address - Street 2:SUITE 1
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207
Mailing Address - Country:US
Mailing Address - Phone:209-957-1244
Mailing Address - Fax:209-957-2591
Practice Address - Street 1:1545 SAINT MARKS PLAZA
Practice Address - Street 2:SUITE 2
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207
Practice Address - Country:US
Practice Address - Phone:209-957-1244
Practice Address - Fax:209-957-2591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-05
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory