Individual
BONITA POE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2100 5TH ST, DAVIS, CA 95618-6591
(530) 747-3400
(530) 753-0398
Mailing address
2100 5TH ST, DAVIS, CA 95618-6591
(530) 747-3400
(530) 753-0398
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
04/04/2008
Last updated
04/04/2008
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