MANTECA MEDICAL GROUP, INC (NPI# 1437113065) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1437113065 |
| Entity Type | Organization |
| Organization Name | MANTECA MEDICAL GROUP, INC |
| Practice Address |
1262 E North St Manteca CA 95336-4962 |
| Practice Telephone | 2098237646 |
| Practice Fax Number | 2098245374 |
| Mailing Telephone | 2098237646 |
| Mailing Fax Number | 2098245374 |
| Enumeration Date | 2006-04-12 |
| Last Update Date | 2010-04-09 |
| Authorized Official Name | DR. TERRY CROASDALE (CFO/COO) |
| Authorized Official Telephone | 2098237646 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207V00000X | Obstetrics & Gynecology | 20A7379 | CA | Allopathic & Osteopathic Physicians |
| N | 207R00000X | Internal Medicine | A54203 | CA | Allopathic & Osteopathic Physicians |
| N | 207V00000X | Obstetrics & Gynecology | G55402 | CA | Allopathic & Osteopathic Physicians |
| N | 208000000X | Pediatrics | A51139 | CA | Allopathic & Osteopathic Physicians |
| N | 208000000X | Pediatrics | A50060 | CA | Allopathic & Osteopathic Physicians |
| N | 207Q00000X | Family Medicine | A24460 | CA | Allopathic & Osteopathic Physicians |
| Y | 207R00000X | Internal Medicine | C43012 | CA | Allopathic & Osteopathic Physicians |
| Street Address |
1262 E NORTH ST |
| City | MANTECA |
| State | CA |
| Zip Code | 95336-4962 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447258272 | Bliss Watson Clark II | Orthopaedic Surgery | 1262 E North St, Manteca, CA 95336-4962 | 2005-07-14 |
| 1891250197 | Paola Velosa | Nurse Practitioner | 1262 E North St, Manteca, CA 95336 | 2019-01-31 |
| 1821355777 | First Choice Physician Partners | Ophthalmology | 1262 E North St, Ste B, Manteca, CA 95336-4962 | 2012-04-17 |
| 1134499411 | Greater Modesto Medical Surgical Associates, Inc. | Orthopaedic Surgery | 1262 E North St, Suite B, Manteca, CA 95336-4962 | 2012-01-04 |
| 1447543160 | Gail R Joseph | Obstetrics & Gynecology | 1262 E North St, Manteca, CA 95336-4962 | 2011-05-27 |
| 1386943546 | Janna Bernice Brocchini | Registered Nurse | 1262 E North St, Manteca, CA 95336-4962 | 2011-03-26 |
| 1386821452 | Linda L Pickhartz | Nurse Practitioner | 1262 E North St, Manteca, CA 95336-4962 | 2008-01-30 |
| 1952586067 | M. Jacqueline Galang Inc. | Internal Medicine | 1262 E North St, Manteca, CA 95336 | 2008-01-08 |
| 1992819957 | Prayuk A. Waran | Obstetrics & Gynecology | 1262 E North St, Manteca, CA 95336 | 2006-08-18 |
| 1326094715 | Edward Joseph Stanford | Obstetrics & Gynecology | 1262 E North St, Manteca, CA 95336 | 2006-05-26 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225687676 | Kasside Sahagun-escalante | Behavior Technician | 402 Victory Ave, Manteca, CA 95336 | 2019-09-09 |
| 1295253797 | Adriana Pena | Counselor | 129 E.center Street Ste.3, Manteca, CA 95336 | 2017-09-05 |
| 1104352277 | Native Directions Inc. | Substance Abuse Rehabilitation Facility | 13505 Union Rd, Manteca, CA 95336 | 2017-05-10 |
| 1437508389 | Anna Gavin | Contractor | 1256 W. Lathrop Rd #376, Manteca, CA 95336 | 2016-06-10 |
| 1164826137 | Michael M. Catz, M.d., Inc | Anesthesiology | 1205 E. North Street, Manteca, CA 95336 | 2014-10-20 |
| 1033518923 | Leanne Louis | Community Health Worker | 129 E Center Street, #3, Manteca, CA 95336 | 2014-08-18 |
| 1255684122 | Kenneth S. Ching, Md., Inc | Anesthesiology | 1205 East North Street, Manteca, CA 95336 | 2012-10-17 |
| 1629323043 | Harpradeep Ratia | Dentist | 1332 E Yosemite Ave, Manteca, CA 95336 | 2012-07-23 |
| 1750643664 | Shelley Marie Kohl | Specialist/Technologist, Other | 425 E. Center St Suite 1, Manteca, CA 95336 | 2012-06-15 |
| 1932488038 | Valerie Diane Segura | Behavioral Analyst | 1882 Cherrywood Pl, Manteca, CA 95336 | 2011-08-08 |
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| Taxonomy Code | 207R00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932442704 | Gilda Camama | Internal Medicine | 1287 Maple Valley St, Manteca, CA 95336-5123 | 2013-03-31 |
| 1033409644 | Swati Pathak | Internal Medicine | 165 Saint Dominics Dr Ste 201, Manteca, CA 95337-7802 | 2011-04-15 |
| 1518128222 | Anita Kumari | Internal Medicine | 1138 Norman Dr, Manteca, CA 95336 | 2008-06-24 |
| 1053399980 | Abdul Waheed Khan | Internal Medicine | 1144 Norman Dr, Suite 205, Manteca, CA 95336-5925 | 2005-12-30 |
| 1760465710 | Randall Kelvin Yee | Internal Medicine | 165 Saint Dominics Dr, Suite #201, Manteca, CA 95337-7802 | 2005-11-23 |
| 1659354868 | Rahul Lalitchandra Patel | Internal Medicine | 1148 Norman Dr, Ste 4, Manteca, CA 95336-5961 | 2005-11-22 |
| 1992791180 | Anil K Sain | Internal Medicine | 1140 Norman Dr, Suite 1, Manteca, CA 95336-5900 | 2005-09-22 |
| 1851742118 | Kyi Lay San | Internal Medicine | 165 Saint Dominics Dr Ste 201, Manteca, CA 95337-7802 | 2016-06-28 |
| 1104238104 | Samuel Antonio Galicia | Internal Medicine | 1721 W Yosemite Ave, Manteca, CA 95337-5130 | 2014-05-24 |
| 1457783458 | Yosemite Inpatient Services, A Medical Corporation | Internal Medicine | 1205 E North St, Manteca, CA 95336-4932 | 2013-08-01 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.