Provider Demographics
NPI:1154135234
Name:CITY OF STOCKTON, OFFICE OF VIOLENCE PREVENTION
Entity type:Organization
Organization Name:CITY OF STOCKTON, OFFICE OF VIOLENCE PREVENTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LORA
Authorized Official - Middle Name:
Authorized Official - Last Name:LARSON
Authorized Official - Suffix:
Authorized Official - Credentials:ASW
Authorized Official - Phone:209-937-5614
Mailing Address - Street 1:425 N EL DORADO ST
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95202-1951
Mailing Address - Country:US
Mailing Address - Phone:209-937-5614
Mailing Address - Fax:
Practice Address - Street 1:425 N EL DORADO ST
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95202-1951
Practice Address - Country:US
Practice Address - Phone:209-937-5614
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-06
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes405300000XOther Service ProvidersPrevention ProfessionalGroup - Single Specialty