Healthcare Provider Details

I. General information

NPI: 1750298766
Provider Name (Legal Business Name): PRABHSHARAN KAUR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 BROOKSIDE RD
STOCKTON CA
95211-0001
US

IV. Provider business mailing address

751 BROOKSIDE RD
STOCKTON CA
95211-0001
US

V. Phone/Fax

Practice location:
  • Phone: 209-946-2561
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberINT52811
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: