Healthcare Provider Details

I. General information

NPI: 1316187362
Provider Name (Legal Business Name): SOKCHEAR S SOUS-FIGUEROA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2009
Last Update Date: 07/11/2024
Certification Date: 07/11/2024
Deactivation Date: 09/02/2022
Reactivation Date: 02/23/2023

III. Provider practice location address

1212 N CALIFORNIA ST
STOCKTON CA
95202-1552
US

IV. Provider business mailing address

1212 N CALIFORNIA ST
STOCKTON CA
95202-1552
US

V. Phone/Fax

Practice location:
  • Phone: 209-468-0131
  • Fax:
Mailing address:
  • Phone: 209-468-0131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95268104
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: