SUTTER GOULD MEDICAL FOUNDATION NPI 1063468106

NPI Information

  • NPI: 1063468106
  • Provider Name: SUTTER GOULD MEDICAL FOUNDATION
  • Classification: Family Medicine - 207Q00000X
  • Entity Type: Organization
  • Doing Business As: LODI AVE CARE CENTER
  • CLIA Number: 05D0684421
  • Address: 1300 W LODI AVE
    STE P
    LODI, CA
    ZIP 95242
  • Phone: (209) 366-1990

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NPI Details

SUTTER GOULD MEDICAL FOUNDATION is a family medicine in Lodi, CA. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. SUTTER GOULD MEDICAL FOUNDATION NPI is 1063468106. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Lodi Ave Care Center.

The provider's business location address is:

1300 W LODI AVE
STE P
LODI, CA
ZIP 95242-000
Phone: (209) 366-1990

The provider's authorized official is Steven A Mitnick .
The authorized official title is Medical Director and has the following contact phone number (209) 521-6097.

The CLIA number assigned to this NPI record is 05D0684421 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 5/26/2006 and was last updated on 5/6/2010.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1208000000XPediatricsNo
2207Q00000XFamily MedicineYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1ZZZ20685ZMEDICARE ID-TYPE UNSPECIFIEDCALIFORNIAMEDICARE NUMBER
20586060019MEDICARE NSCCALIFORNIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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