Facts
- Status
- A
- Type
- Individual
- Enumeration date
- 2026-05-28
- Last updated
- 2026-05-28
Licenses
- License CA
- Number not in the file
Location
- Practice location
- 333 N SAN JOAQUIN ST
- City
- STOCKTON CA
- Postal code
- 952022954
- Phone
- 209-993-7663
Medicare
- PECOS
- No PECOS enrollment row matched this NPI.
LEIE
The OIG NPI list is not in this build yet. Confirm on OIG's search.
Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.