Healthcare Provider Details

I. General information

NPI: 1881399129
Provider Name (Legal Business Name): MRS. KIMBERLY ANN VAKOC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIMBERLY ANN KRETSCHMANN

II. Dates (important events)

Enumeration Date: 04/04/2023
Last Update Date: 03/24/2025
Certification Date: 03/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2495 W MARCH LN
STOCKTON CA
95207-8251
US

IV. Provider business mailing address

2495 W MARCH LN
STOCKTON CA
95207-8251
US

V. Phone/Fax

Practice location:
  • Phone: 209-337-7190
  • Fax:
Mailing address:
  • Phone: 209-337-7190
  • Fax:

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: