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General NPI Number Information
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NPI Number | 1750193199
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Entity Type | Individual
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Provider Name | KIMBERLY RAQUEL ROBINSON
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Gender | Female
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Dates
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Enumeration Date | 01/23/2025
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Last Update Date | 01/23/2025
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Provider Practice Location Address
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Address Line | 110 N SAN JOAQUIN ST # 322
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City | STOCKTON
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State | CA
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Zip | 95202-2400
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Country | US
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Telephone | 530-680-9347
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Fax |
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Provider Business Mailing Address
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Address Line | 15779 INDEPENDENCE AVE
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City | LATHROP
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State | CA
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Zip | 95330-9440
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Country | US
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Telephone | 530-680-9347
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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 | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State | CA
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