Healthcare Provider Details

I. General information

NPI: 1104636182
Provider Name (Legal Business Name): RIMA BARKETT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2025
Last Update Date: 04/02/2025
Certification Date: 04/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 N EL DORADO ST
STOCKTON CA
95202-2308
US

IV. Provider business mailing address

110 N EL DORADO ST
STOCKTON CA
95202-2308
US

V. Phone/Fax

Practice location:
  • Phone: 209-608-5455
  • Fax:
Mailing address:
  • Phone: 209-608-5455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: