Healthcare Provider Details

I. General information

NPI: 1497689152
Provider Name (Legal Business Name): OAKSTONE PSYCHIATRIC PRACTICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3435 S DEMAREE ST STE C
VISALIA CA
93277-7006
US

IV. Provider business mailing address

3435 S DEMAREE ST STE C
VISALIA CA
93277-7006
US

V. Phone/Fax

Practice location:
  • Phone: 559-258-1644
  • Fax: 559-258-1624
Mailing address:
  • Phone: 559-258-1644
  • Fax: 559-258-1624

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: CORY JAQUES
Title or Position: OWNER/CEO
Credential: MD
Phone: 507-312-0165