Healthcare Provider Details

I. General information

NPI: 1255573895
Provider Name (Legal Business Name): MRS. ROXANNE VALERGA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2009
Last Update Date: 03/28/2009
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

1212 N CALIFORNIA ST
STOCKTON CA
95202-1552
US

V. Phone/Fax

Practice location:
  • Phone: 209-468-8660
  • Fax: 209-486-2084
Mailing address:
  • Phone: 209-468-8660
  • Fax: 209-486-2084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License NumberPT33812
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: