Healthcare Provider Details

I. General information

NPI: 1619563848
Provider Name (Legal Business Name): SARA KATHERINE BOCK NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2020
Last Update Date: 02/09/2021
Certification Date: 02/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 E. DAVIS AVE.
PIXLEY CA
93256
US

IV. Provider business mailing address

205 E. DAVIS AVENUE
PIXLEY CA
93256-9374
US

V. Phone/Fax

Practice location:
  • Phone: 559-757-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95016224
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: