Healthcare Provider Details

I. General information

NPI: 1770606386
Provider Name (Legal Business Name): ANN-VALERIE PLAZA FOJAS-GARCIA REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 01/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1212 N CALIFORNIA ST
STOCKTON CA
95202-1552
US

IV. Provider business mailing address

5628 WESTCHESTER CIR
STOCKTON CA
95219-7169
US

V. Phone/Fax

Practice location:
  • Phone: 209-468-8660
  • Fax:
Mailing address:
  • Phone: 209-951-0747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code167G00000X
TaxonomyLicensed Psychiatric Technician
License NumberPT27085
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN 704233
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: