Healthcare Provider Details

I. General information

NPI: 1689358210
Provider Name (Legal Business Name): SARET KHOR LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2023
Last Update Date: 06/14/2023
Certification Date: 06/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10148 BLUE ANCHOR LN
STOCKTON CA
95219-7251
US

IV. Provider business mailing address

10148 BLUE ANCHOR LN
STOCKTON CA
95219-7251
US

V. Phone/Fax

Practice location:
  • Phone: 209-687-3111
  • Fax:
Mailing address:
  • Phone: 209-687-3111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number702396
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: