Individual
JERAD ALAN SOUZA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
P.T.
Contact information
Practice address
720 WOOD ST, EUREKA, CA 95501-4413
(707) 268-2990
Mailing address
1771 HAWKES RD, MCKINLEYVILLE, CA 95519-4110
(805) 441-0196
Taxonomy
Speciality
Code
Description
License number
State
374700000X
Technician
Primary
PT32451
CA
Other
Enumeration date
04/14/2009
Last updated
05/15/2009
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