Healthcare Provider Details

I. General information

NPI: 1417883323
Provider Name (Legal Business Name): RISE RESOURCE CENTER CA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5250 CLAREMONT AVE STE 100
STOCKTON CA
95207-5666
US

IV. Provider business mailing address

5250 CLAREMONT AVE STE 100
STOCKTON CA
95207-5666
US

V. Phone/Fax

Practice location:
  • Phone: 702-885-1441
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: AMIYNA WASHINGTON
Title or Position: CEO
Credential:
Phone: 702-885-1441