MEDICARE: CITY OF STOCKTON, OFFICE OF VIOLENCE PREVENTION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	405300000X	Prevention Professional

General Provider Information

NPI Number	:	1154135234
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY OF STOCKTON, OFFICE OF VIOLENCE PREVENTION

Provider Business Mailing Address
First Line	:	425 N EL DORADO ST
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95202-1951
Country	:	US
Telephone Number	:	209-937-5614
Fax Number	:

Provider Business Practice Location Address
First Line	:	425 N EL DORADO ST
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95202-1951
Country	:	US
Telephone Number	:	209-937-5614
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	LORA LARSON
Credential	:	ASW
Telephone Number	:	209-937-5614

Provider Enumeration Date	:	02/06/2025
Last Update Date	:	02/06/2025

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Directions to “CITY OF STOCKTON, OFFICE OF VIOLENCE PREVENTION ” Practice Location

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