Provider Demographics
NPI:1992736599
Name:DOCTORS HOSPITAL OF MANTECA, INC.
Entity type:Organization
Organization Name:DOCTORS HOSPITAL OF MANTECA, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ROB
Authorized Official - Middle Name:
Authorized Official - Last Name:GIORGIANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-823-8361
Mailing Address - Street 1:PO BOX 57435
Mailing Address - Street 2:FILE 57435
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90074-7435
Mailing Address - Country:US
Mailing Address - Phone:209-578-2513
Mailing Address - Fax:209-239-8329
Practice Address - Street 1:1205 E NORTH ST
Practice Address - Street 2:
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95336-4932
Practice Address - Country:US
Practice Address - Phone:209-823-3111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA030000203282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
163607300OtherAETNA US HEALTHCARE (NATI
CAZZR00118GMedicaid
CAHSP40118GMedicaid
CAHSC30118GMedicaid
ZZZC3910ZOtherBS OF CALIFORNIA
000413OtherHUMANA
005073-0001OtherPACIFICARE OF CALIFORNIA
CAHSP40118HMedicaid
CAHSC00118GMedicaid
CAHSC00118GMedicaid