Individual
ISHAK SITANGGANG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
400 N PEPPER AVE, COLTON, CA 92324-1801
(909) 580-3144
Mailing address
400 N PEPPER AVE, COLTON, CA 92324-1801
(909) 580-3144
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
750857
CA
Other
Enumeration date
03/23/2010
Last updated
03/23/2010
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