Individual provider · Type 1 NPI

Kelly Roughgarden

Student in an Organized Health Care Education/Training Program · Stockton, CA

NPI number 1174077614 Active

Practice location

5405 N Pershing Ave, Ste. C-1
Stockton, CA 95207-5451

Call (209) 476-1959 Map

Mailing address

3601 Pacific Ave
Stockton, CA 95211-0110

Specialties and licenses

TaxonomyCodeLicense
Student in an Organized Health Care Education/Training Program Primary 390200000XNone listed

Student in an Organized Health Care Education/Training Program: An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

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About NPI 1174077614

Kelly Roughgarden's National Provider Identifier is 1174077614, issued on Aug 13, 2016. The primary taxonomy on file is Student in an Organized Health Care Education/Training Program (390200000X), and the practice location is in Stockton, CA. The record was last updated on Aug 13, 2016.