Healthcare Provider Details

I. General information

NPI: 1588577654
Provider Name (Legal Business Name): KORY KAMBARA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6844 ALEXANDRIA PL
STOCKTON CA
95207-2498
US

IV. Provider business mailing address

6844 ALEXANDRIA PL
STOCKTON CA
95207-2498
US

V. Phone/Fax

Practice location:
  • Phone: 209-953-8935
  • Fax:
Mailing address:
  • Phone: 209-953-8935
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number220012481
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: