Provider Demographics
NPI:1730583865
Name:FOJO, KRISTY
Entity type:Individual
Prefix:
First Name:KRISTY
Middle Name:
Last Name:FOJO
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 1:812 W CLOVER RD SPC 25
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95376-1710
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5405 N PERSHING AVE
Practice Address - Street 2:STE. C-1
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-5451
Practice Address - Country:US
Practice Address - Phone:209-476-1959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-17
Last Update Date:2014-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program