Healthcare Provider Details

I. General information

NPI: 1972182970
Provider Name (Legal Business Name): THE PACIFIC RESILIENCY CENTER FOR PSYCHOLOGY, WELLNESS, AND THE ARTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2021
Last Update Date: 04/09/2021
Certification Date: 04/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3134 PACIFIC AVE
STOCKTON CA
95204-3640
US

IV. Provider business mailing address

3134 PACIFIC AVE
STOCKTON CA
95204-3640
US

V. Phone/Fax

Practice location:
  • Phone: 209-910-3383
  • Fax: 866-256-0351
Mailing address:
  • Phone: 209-910-3383
  • Fax: 866-256-0351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. KAREN RAE SANCHEZ
Title or Position: PRESIDENT
Credential: PSYD
Phone: 209-910-3383