Provider Demographics
NPI:1073724498
Name:STOCKTON HAND THERAPY & REHABILITATION
Entity Type:Organization
Organization Name:STOCKTON HAND THERAPY & REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARIANNE
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:CABALLERO-RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:OTR, CHT
Authorized Official - Phone:209-956-8737
Mailing Address - Street 1:1919 GRAND CANAL BLVD
Mailing Address - Street 2:SUITE C4
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-8114
Mailing Address - Country:US
Mailing Address - Phone:209-956-8737
Mailing Address - Fax:209-956-2586
Practice Address - Street 1:1919 GRAND CANAL BLVD
Practice Address - Street 2:SUITE C4
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-8114
Practice Address - Country:US
Practice Address - Phone:209-956-8737
Practice Address - Fax:209-956-2586
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2470332B00000X, 332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5268870001Medicare NSC