Provider Demographics
NPI:1205235173
Name:SOU, VANPISEY
Entity type:Individual
Prefix:
First Name:VANPISEY
Middle Name:
Last Name:SOU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3520 HIGGINS AVE
Mailing Address - Street 2:APT/SUITE
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95205-6810
Mailing Address - Country:US
Mailing Address - Phone:916-813-6346
Mailing Address - Fax:
Practice Address - Street 1:2051 JOHN JONES RD
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-9701
Practice Address - Country:US
Practice Address - Phone:916-403-2970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-17
Last Update Date:2015-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program