Healthcare Provider Details

I. General information

NPI: 1124933726
Provider Name (Legal Business Name): PAVLO KARAPUTA FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

782 E HARDING WAY
STOCKTON CA
95204-6101
US

IV. Provider business mailing address

782 E HARDING WAY
STOCKTON CA
95204-6101
US

V. Phone/Fax

Practice location:
  • Phone: 209-546-5200
  • Fax:
Mailing address:
  • Phone: 209-546-5200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95039936
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: