Healthcare Provider Details

I. General information

NPI: 1437579133
Provider Name (Legal Business Name): SUSAN OKPARA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2014
Last Update Date: 01/03/2022
Certification Date: 01/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1031 WATERLOO RD
STOCKTON CA
95205-4256
US

IV. Provider business mailing address

1031 WATERLOO RD
STOCKTON CA
95205-4256
US

V. Phone/Fax

Practice location:
  • Phone: 209-373-2816
  • Fax:
Mailing address:
  • Phone: 209-373-2816
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA147066
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: