Healthcare Provider Details

I. General information

NPI: 1992572135
Provider Name (Legal Business Name): BYKEMA MOBLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2023
Last Update Date: 12/17/2024
Certification Date: 12/07/2023
Deactivation Date: 01/25/2024
Reactivation Date: 12/17/2024

III. Provider practice location address

4142 E MORADA LN APT 4201
STOCKTON CA
95212-1687
US

IV. Provider business mailing address

4142 E MORADA LN APT 4201
STOCKTON CA
95212-1687
US

V. Phone/Fax

Practice location:
  • Phone: 510-378-0780
  • Fax:
Mailing address:
  • Phone: 510-378-0780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: