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General NPI Number Information
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NPI Number | 1669062097
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Entity Type | Individual
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Provider Name | SAMANTHA TORIBIO
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Gender | Female
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Dates
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Enumeration Date | 01/20/2021
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Last Update Date | 01/20/2021
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Provider Practice Location Address
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Address Line | 3601 PACIFIC AVE
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City | STOCKTON
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State | CA
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Zip | 95211-0110
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Country | US
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Telephone | 209-946-2888
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Fax |
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Provider Business Mailing Address
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Address Line | 2255 PICCARDO CIR
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City | STOCKTON
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State | CA
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Zip | 95207-6536
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Country | US
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Telephone | 954-809-1407
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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