Healthcare Provider Details

I. General information

NPI: 1215451125
Provider Name (Legal Business Name): ELIZABETH MARIE SALDANA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1212 N. CALIFORNIA ST
STOCKTON CA
95202
US

IV. Provider business mailing address

1212 N CALIFORNIA ST
STOCKTON CA
95202-1552
US

V. Phone/Fax

Practice location:
  • Phone: 209-468-2385
  • Fax: 209-468-8024
Mailing address:
  • Phone: 209-468-2385
  • Fax: 209-468-8024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: