Individual
TISHA LEE KOEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2933 H ST, EUREKA, CA 95501-4407
(707) 441-3783
Mailing address
336 W SONOMA ST, EUREKA, CA 95501-2818
(707) 382-8893
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
CA
Other
Enumeration date
01/06/2020
Last updated
01/06/2020
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