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Provider Information for 1588165609

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know


Gender: FEMALE

Individual NPI: 1588165609

Calendar   Last Updated:  2018-02-23
  Certification Date: 


Name Value
NPI 1588165609
Enumeration Date 2018-02-23
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 5820 STONERIDGE MALL RD STE 205
PLEASANTON, CA 94588-3347
United States

Phone: | Fax:
View Map External Link
Primary Practice Address 1811 GRAND CANAL BLVD STE 2
STOCKTON, CA 95207-8107
United States

Phone: 877-418-2978 | Fax:
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Primary Taxonomy Selected Taxonomy State License Number
Yes 106S00000X - Behavior Technician