Individual
CHAMILLE SEANTE TATE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2180 VALLEY BLVD, POMONA, CA 91768-3325
(909) 865-2336
(909) 865-1831
Mailing address
2180 VALLEY BLVD, POMONA, CA 91768-3325
(909) 865-2336
(909) 865-1831
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
PT37946
CA
Other
Enumeration date
10/12/2017
Last updated
10/12/2017
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