Individual
VANPISEY SOU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2051 JOHN JONES RD, DAVIS, CA 95616-9701
(916) 403-2970
Mailing address
3520 HIGGINS AVE, APT/SUITE, STOCKTON, CA 95205-6810
(916) 813-6346
Taxonomy
Speciality
Code
Description
License number
State
251V00000X
Voluntary or Charitable Agency
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
08/17/2014
Last updated
08/07/2015
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