Individual
ADAM WONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1414 N CALIFORNIA ST, STOCKTON, CA 95202-1515
(209) 468-8686
Mailing address
1414 N CALIFORNIA ST, STOCKTON, CA 95202-1515
(209) 468-8686
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
41676
CA
Other
Enumeration date
07/24/2020
Last updated
07/24/2020
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