Provider Demographics
NPI:1104636182
Name:BARKETT, RIMA
Entity type:Individual
Prefix:
First Name:RIMA
Middle Name:
Last Name:BARKETT
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 N EL DORADO ST
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95202-2308
Mailing Address - Country:US
Mailing Address - Phone:209-608-5455
Mailing Address - Fax:
Practice Address - Street 1:110 N EL DORADO ST
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95202-2308
Practice Address - Country:US
Practice Address - Phone:209-608-5455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-10
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA174200000X, 332U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332U00000XSuppliersHome Delivered Meals
No174200000XOther Service ProvidersMeals