Individual
POONLARP LURSLURCHACHAI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1509 KEATS PL, ROHNERT PARK, CA 94928-5047
(650) 878-7525
Mailing address
1509 KEATS PL, ROHNERT PARK, CA 94928-5047
(650) 878-7525
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
95030638
CA
Other
Enumeration date
12/11/2023
Last updated
07/29/2024
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