Individual
LUIS CORNEJO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1003 LAKE PARK AVE APT 132, GALT, CA 95632-3757
(209) 912-8406
(209) 375-0022
Mailing address
1003 LAKE PARK AVE APT 132, GALT, CA 95632-3757
(209) 912-8406
(209) 375-0022
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
—
—
Other
Enumeration date
01/31/2017
Last updated
01/31/2017
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