Individual
MR. YUTTHANA TOKIJKLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATP
Contact information
Practice address
1972 GINKGO ST, SAN BERNARDINO, CA 92407-2365
(909) 289-5874
Mailing address
1972 GINKGO ST, SAN BERNARDINO, CA 92407-2365
(909) 289-5874
Taxonomy
Speciality
Code
Description
License number
State
225CA2500X
Assistive Technology Supplier Rehabilitation Counselor
Primary
ATP4665
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
941158
BUSINESS LICENSE
CA
01
—
SR EH 102-178362
SELLERS PERMIT
CA
Enumeration date
02/02/2012
Last updated
02/02/2012
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