| NPI | 1669099743 |
|---|---|
| Doing Business As | SAN JOAQUIN CONNECT III FSP |
| Entity Type | Organization |
| Authorized Contact | LORENA LOPEZ Provider Relations Supervisor 510-747-0552 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X |
| Enumeration Date | 2020-07-06 |
| Last Update Date | 2023-04-19 |