Individual
KRISTOPHER PALLESEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
5910 PACIFIC AVE, STOCKTON, CA 95207-4704
(209) 475-1000
Mailing address
5910 PACIFIC AVE, STOCKTON, CA 95207-4704
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
11071
CA
Other
Enumeration date
09/28/2015
Last updated
09/28/2015
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