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General NPI Number Information
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NPI Number | 1295554699
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Entity Type | Organization
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Legal Business Name | OAK & STONE MANAGEMENT
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Dates
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Enumeration Date | 10/03/2024
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Last Update Date | 10/03/2024
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Provider Practice Location Address
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Address Line | 9015 EMERALD GROVE AVE
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City | LAKESIDE
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State | CA
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Zip | 92040-3603
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Country | US
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Telephone | 916-872-5895
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Fax |
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Provider Business Mailing Address
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Address Line | 9015 EMERALD GROVE AVE
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City | LAKESIDE
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State | CA
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Zip | 92040-3603
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Country | US
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Telephone | 916-872-5895
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BRANDI TERRA
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Credential |
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Telephone | 916-872-5895
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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