Individual
ANOSIKE IKONTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSYCHIATRIC TECHNICI
Contact information
Practice address
10019 TEDDINGTON WAY, ELK GROVE, CA 95624-1339
(909) 702-6218
Mailing address
10019 TEDDINGTON WAY, ELK GROVE, CA 95624-1339
(909) 702-6218
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
PT 34540
CA
Other
Enumeration date
08/01/2016
Last updated
08/01/2016
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