Active NPI
Kristopher Pallesen, PTA
- Specialist
- Stockton, CA
National Provider Identifier
1154791572
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 11071
- Practice address
- 5910 Pacific Ave
Stockton, CA 95207-4704 - Phone
- (209) 475-1000
- NPI assigned
- Sep 28, 2015
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 11071 | CA | Primary |
Addresses
Primary practice location
5910 Pacific Ave
Stockton, CA 95207-4704
Mailing address
5910 Pacific Ave
Stockton, CA 95207-4704
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11071 | CA | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1443398400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1443398400000",
"number": "1154791572",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5910 PACIFIC AVE",
"city": "STOCKTON",
"state": "CA",
"postal_code": "952074704"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5910 PACIFIC AVE",
"city": "STOCKTON",
"state": "CA",
"postal_code": "952074704",
"telephone_number": "209-475-1000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PALLESEN",
"first_name": "KRISTOPHER",
"credential": "PTA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-09-28",
"last_updated": "2015-09-28",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "CA",
"license": "11071",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Stockton, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.