Healthcare Provider Details

I. General information

NPI: 1366599425
Provider Name (Legal Business Name): STACEY ALLISON SOUZA RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 BECK AVE MS 5240
FAIRFIELD CA
94533-6804
US

IV. Provider business mailing address

275 BECK AVE MS 5240
FAIRFIELD CA
94533-6804
US

V. Phone/Fax

Practice location:
  • Phone: 707-784-8070
  • Fax: 707-438-2500
Mailing address:
  • Phone: 707-784-8070
  • Fax: 707-438-2500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number444255
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: