Individual
TYDA VIVEROS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1111 N EL DORADO ST, STOCKTON, CA 95202-1305
(209) 938-0228
(209) 938-0281
Mailing address
1111 N. ELDORADO STREET, STOCKTON, CA 95202
(209) 938-0228
(209) 938-0281
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
37052
CA
Other
Enumeration date
04/17/2017
Last updated
04/17/2017
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