Healthcare Provider Details

I. General information

NPI: 1770446692
Provider Name (Legal Business Name): NICOLE PATRICE ROBINSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1803 W MARCH LN STE C
STOCKTON CA
95207-6414
US

IV. Provider business mailing address

8646 KELLEY DR
STOCKTON CA
95209-2165
US

V. Phone/Fax

Practice location:
  • Phone: 916-840-1583
  • Fax:
Mailing address:
  • Phone: 916-840-1583
  • Fax: 209-636-5356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: