Healthcare Provider Details

I. General information

NPI: 1851882591
Provider Name (Legal Business Name): STEPHANIE ROCHELLE DAROSA FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: STEPHANIE R SLATON

II. Dates (important events)

Enumeration Date: 05/29/2018
Last Update Date: 06/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1721 E HAMMER LN
STOCKTON CA
95210
US

IV. Provider business mailing address

7210 MURRAY DR
STOCKTON CA
95210-3339
US

V. Phone/Fax

Practice location:
  • Phone: 209-751-5200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95009080
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: