Individual
TARA LEIGH JOAQUIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
1350 E GRAND AVE, ARROYO GRANDE, CA 93420-2422
(805) 474-2170
Mailing address
2180 JOHNSON AVE, SAN LUIS OBISPO, CA 93401-4558
(805) 781-4275
(805) 781-1227
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
PT34771
CA
Other
Enumeration date
12/18/2018
Last updated
05/13/2019
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