Individual
MARY FLUKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPT
Contact information
Practice address
2180 VALLEY BLVD, POMONA, CA 91768-3325
(909) 865-2336
Mailing address
9335 GLENDON WAY, ROSEMEAD, CA 91770-2006
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
30171
CA
Other
Enumeration date
04/09/2019
Last updated
04/09/2019
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