Individual
MISS CHARLENE JADE CRISOSTOMO PREMYODHIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
312 PLYMOUTH AVE, SAN FRANCISCO, CA 94112-3026
(714) 452-7776
(415) 776-1006
Mailing address
312 PLYMOUTH AVE, SAN FRANCISCO, CA 94112-3026
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38BF3
—
CA
Enumeration date
05/24/2007
Last updated
07/08/2007
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