| Organization Name: | MANTECA MEDICAL GROUP, INC |
| NPI Number: | 1437113065 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | TERRY CROASDALE (CFO/COO) |
| Mailing Address: | 1262 E North St Manteca |
| State: | CA US |
| Postal Code: | 953364962 |
| Phone Number: | 2098237646 |
| Fax Number: | 2098245374 |
| NPI Enumeration Date: | 04/12/2006 |
| NPI Last Update Date: | 04/09/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207V00000X |
| License Number: | 20A7379 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | CA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Obstetrics & Gynecology |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women. |