Individual
CARL MIRAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1450 BESSIE AVE STE B, TRACY, CA 95376-3456
(209) 597-3090
Mailing address
1450 BESSIE AVE STE B, TRACY, CA 95376-3456
(209) 597-3090
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
42694
CA
Other
Enumeration date
04/19/2024
Last updated
04/19/2024
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