Individual
MRS. JACQUENE J RICHARDSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3875 S WESTERN AVE, LOS ANGELES, CA 90062-1105
(323) 290-4373
Mailing address
498 W. 59TH STREET, SAN BERNARDINO, CA 92407
(323) 290-4373
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
PT36012
CA
Other
Enumeration date
07/27/2011
Last updated
08/01/2011
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