Individual
JASMINE SOURIVONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2185 W ROSE ST, STOCKTON, CA 95203-1208
(510) 593-1835
Mailing address
7200 BANCROFT AVE STE 267, OAKLAND, CA 94605-2403
(510) 593-1835
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
CA
Other
Enumeration date
08/16/2022
Last updated
08/16/2022
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