Healthcare Provider Details

I. General information

NPI: 1174433478
Provider Name (Legal Business Name): KATHLEEN QUIAOT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1661 WILLOW PARK WAY
STOCKTON CA
95206-4834
US

IV. Provider business mailing address

1661 WILLOW PARK WAY
STOCKTON CA
95206-4834
US

V. Phone/Fax

Practice location:
  • Phone: 209-808-8140
  • Fax:
Mailing address:
  • Phone: 209-808-8140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376G00000X
TaxonomyNursing Home Administrator
License Number7033329735
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: