Healthcare Provider Details

I. General information

NPI: 1538043740
Provider Name (Legal Business Name): KRISTINA RENEE FREDRICK-POND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTINA RENEE COOK

II. Dates (important events)

Enumeration Date: 08/01/2025
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

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: 209-468-8700
  • Fax:
Mailing address:
  • Phone: 209-468-8700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberMPSS-RXVLZH
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: