Healthcare Provider Details

I. General information

NPI: 1306355839
Provider Name (Legal Business Name): JASMINE PADDA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2017
Last Update Date: 06/05/2023
Certification Date: 06/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 E CHANNEL ST
STOCKTON CA
95202-2628
US

IV. Provider business mailing address

1 UNIVERSITY CIR
TURLOCK CA
95382-3200
US

V. Phone/Fax

Practice location:
  • Phone: 209-944-4700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95022094
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WC1400X
TaxonomyCollege Health Registered Nurse
License Number845333
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: