Healthcare Provider Details

I. General information

NPI: 1417539230
Provider Name (Legal Business Name): ALISSA SABATINO SHEPARD DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALISSA MARIE SABATINO DO

II. Dates (important events)

Enumeration Date: 04/21/2021
Last Update Date: 09/29/2026
Certification Date: 02/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 N CALIFORNIA ST
STOCKTON CA
95204-6019
US

IV. Provider business mailing address

2512 CHARDONNAY LN
LODI CA
95242-8201
US

V. Phone/Fax

Practice location:
  • Phone: 209-943-2000
  • Fax:
Mailing address:
  • Phone: 602-819-1145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number20A21055
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberR3630
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: