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Specialty details in registry · Stockton, CA

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At a glance

8712 Ensenada Dr, Stockton, CA 95210-1213

NPPES record updated Jul 17, 2014. Public records can lag behind changes at a practice.

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Insurance participation and appointment availability are not established by these public records.

Practice location

8712 Ensenada Dr
Stockton, CA 95210-1213

Professional details: NPI, taxonomy & registry record

NPI1730596214

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Registry details

Primary taxonomy: Specialty details in registry
Taxonomy code: 313M00000X
Enumeration date: Jul 17, 2014
Record updated: Jul 17, 2014

More registry details

Provider type: Organization · Type 2

Reported taxonomies and licenses

Specialty details in registry

313M00000X · Primary

License numbers and credentials are reported to NPPES; HCPList does not independently verify them.

Practice location

8712 Ensenada Dr
Stockton, CA 95210-1213

Phone: (209) 476-0541

Mailing address

9559 COLINGTON PL

STOCKTON, CA 952095013

Source: NPPES Source through Oct 18, 2026An NPI does not verify licensure or credentials.

Information may be outdated or incomplete. Confirm details directly with the practice. HCPList is an independent directory and is not affiliated with CMS.

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