Individual
SAMBO POT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1212 N CALIFORNIA ST, STOCKTON, CA 95202-1552
(209) 468-8661
Mailing address
1212 N CALIFORNIA ST, STOCKTON, CA 95202-1552
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
PT33626
CA
Other
Enumeration date
10/28/2016
Last updated
10/28/2016
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