Healthcare Provider Details

I. General information

NPI: 1851515720
Provider Name (Legal Business Name): MARIA SOCORRO SESANTE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 07/08/2007
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

9110 CHIANTI CIR
STOCKTON CA
95212-3815
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code167G00000X
TaxonomyLicensed Psychiatric Technician
License NumberPT30936
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: