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General NPI Number Information
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NPI Number | 1407706211
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Entity Type | Organization
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Legal Business Name | INEZA OUTPATIENT SERVICES
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Dates
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Enumeration Date | 01/30/2026
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Last Update Date | 01/30/2026
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Provider Practice Location Address
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Address Line | 7488 SHORELINE DR STE B3
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City | STOCKTON
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State | CA
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Zip | 95219-5433
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Country | US
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Telephone | 209-453-5373
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Fax |
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Provider Business Mailing Address
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Address Line | 7488 SHORELINE DR STE B3
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City | STOCKTON
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State | CA
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Zip | 95219-5433
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Country | US
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Telephone | 209-453-5373
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MOHAMED GATIKABISI
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Credential | SIR
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Telephone | 207-409-8759
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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