Individual
ANDREA IACONO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RADT-1
Contact information
Practice address
2781 W RAMSEY ST., BANNING, CA 92220-5528
(951) 849-3896
Mailing address
2781 W RAMSEY ST, BANNING, CA 92220-3700
(951) 849-3896
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
R1001014
CA
Other
Enumeration date
10/20/2014
Last updated
03/27/2015
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