Healthcare Provider Details

I. General information

NPI: 1144907304
Provider Name (Legal Business Name): MRS. GUADALUPE NONE DUTRA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2023
Last Update Date: 06/29/2023
Certification Date: 06/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2311 CHAPEL HILL CIR
STOCKTON CA
95209-4009
US

IV. Provider business mailing address

2311 CHAPEL HILL CIR
STOCKTON CA
95209-4009
US

V. Phone/Fax

Practice location:
  • Phone: 200-993-5161
  • Fax:
Mailing address:
  • Phone: 200-993-5161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374700000X
TaxonomyTechnician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: