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| Type | Person | [sources] | |||
|---|---|---|---|---|---|
| Name | Jerrold Polterock | [sources] | |||
| Birth date | not available | [sources] | |||
| Nationality | not available | [sources] | |||
| Country | United States | [sources] | |||
| First name | Jerrold | [sources] | |||
| Last name | Polterock | [sources] | |||
| Registration number | 00G163470 · 00G163471 · 1417126178 · 1578536306 · CGP166838 · | [sources] | |||
| Sector | Physician | [sources] | |||
| Address | 250 S. Wood Ave., Apt. 30, Oakdale, CA 95361 | [sources] | |||
| Last change | Last processed | First seen | |||
Medical providers suspended from or otherwise deemed ineligible to participate in California's Medicaid program.
United States · DHCS
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