Healthcare Provider Details

I. General information

NPI: 1558639716
Provider Name (Legal Business Name): LENEE JOY CAYABYAB NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2011
Last Update Date: 02/09/2024
Certification Date: 02/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5757 PACIFIC AVE STE 228
STOCKTON CA
95207-5159
US

IV. Provider business mailing address

3827 N 10TH ST STE 305
MCALLEN TX
78501-1745
US

V. Phone/Fax

Practice location:
  • Phone: 209-490-5050
  • Fax:
Mailing address:
  • Phone: 956-803-0748
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95089143
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License NumberVN258972
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95027481
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: