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NPI Code Detail

MEDICARE: ROBYN PRIMACK RD

MEDICARE: ROBYN PRIMACK RD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1133V00000XRegistered Dietitian86111640CA

General Provider Information

NPI Number : 1205713245
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROBYN PRIMACK RD
Provider Business Mailing Address
First Line : 782 E HARDING WAY
Second Line :
City : STOCKTON
State : CA
Zip : 95204-6101
Country : US
Telephone Number : 209-546-5200
Fax Number :
Provider Business Practice Location Address
First Line : 782 E HARDING WAY
Second Line :
City : STOCKTON
State : CA
Zip : 95204-6101
Country : US
Telephone Number : 209-546-5200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/20/2025
Last Update Date : 08/20/2025

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Directions to “ ROBYN PRIMACK RD” Practice Location

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