Provider Demographics
NPI:1548333743
Name:B ST J MEDICAL CORPORATION
Entity type:Organization
Organization Name:B ST J MEDICAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:J
Authorized Official - Last Name:HYLTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-723-2132
Mailing Address - Street 1:750 W OLIVE AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95348-2436
Mailing Address - Country:US
Mailing Address - Phone:209-723-2132
Mailing Address - Fax:209-723-3017
Practice Address - Street 1:750 W OLIVE AVE
Practice Address - Street 2:STE 105
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95348
Practice Address - Country:US
Practice Address - Phone:209-723-2132
Practice Address - Fax:209-723-3017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
A49332Medicare UPIN
CA00A412250Medicare UPIN