Individual
BLAIR WISHOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2495 W MARCH LN STE 125, STOCKTON, CA 95207-8224
(209) 320-7675
Mailing address
2495 W MARCH LN STE 125, STOCKTON, CA 95207-8224
(209) 320-7675
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
172V00000X
Community Health Worker
Primary
—
—
Other
Enumeration date
12/16/2015
Last updated
12/13/2023
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