Individual
MARISOL GRANADOS VILLAGRAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4545 GEORGETOWN PL STE D, STOCKTON, CA 95207-6229
(209) 269-5587
Mailing address
4545 GEORGETOWN PL STE D, STOCKTON, CA 95207-6229
(209) 269-5587
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
—
—
Other
Enumeration date
10/24/2022
Last updated
09/19/2023
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