Organization
KAISER PERMANENTE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DOREEN SAMELSON EDD (BEHAVIORAL HEALTH MANAGER III)
(209) 858-7754
Entity
Organization
Contact information
Practice address
7373 WEST LN, STOCKTON, CA 95210-3377
(209) 476-5115
Mailing address
7373 WEST LN, STOCKTON, CA 95210-3377
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
27250
CA
Other
Enumeration date
08/04/2011
Last updated
08/04/2011
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