WELLBOUND OF STOCKTON LLC NPI 1144260811

NPI Information

WELLBOUND OF STOCKTON LLC is an end-stage renal disease (esrd) treatment clinic center in Stockton, CA. WELLBOUND OF STOCKTON LLC NPI is 1144260811. The provider is registered as an organization entity type.
The provider Is Doing Business As Wellbound Of Stockton.

The provider's business location address is:

3555 DEER PARK DR
SUITE 140
STOCKTON, CA
ZIP 95219-306
Phone: (209) 955-5630
Fax: (209) 955-5635

The provider's authorized official is Bernadette Vincent .
The authorized official title is President/coo and has the following contact phone number (650) 404-3600.

The CLIA number assigned to this NPI record is 05D1055539 - end stage renal disease dialysis facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 6/8/2006 and was last updated on 1/19/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

Other Identifiers

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