Healthcare Provider Details

I. General information

NPI: 1477260644
Provider Name (Legal Business Name): PAULINA BARE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2022
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1811 GRAND CANAL BLVD STE 2
STOCKTON CA
95207-8107
US

IV. Provider business mailing address

891 MOUNTAIN RANCH RD
SAN ANDREAS CA
95249-9713
US

V. Phone/Fax

Practice location:
  • Phone: 877-418-2978
  • Fax:
Mailing address:
  • Phone: 209-754-6525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: