Individual
MS. ISATA S MBAWA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPT
Contact information
Practice address
4987 SPEAK LN, SAN JOSE, CA 95118-2767
(408) 417-1164
Mailing address
4987 SPEAK LN, SAN JOSE, CA 95118-2767
(408) 417-1164
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
37848
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
16127819
KAISER PERMANENTE
CA
Enumeration date
11/16/2017
Last updated
11/16/2017
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