Individual
JESSE MALDONADO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
11025 RINGWOOD AVE, SANTA FE SPRINGS, CA 90670-4337
(562) 712-9878
Mailing address
11025 RINGWOOD AVE, SANTA FE SPRINGS, CA 90670-4337
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
PT 37719
CA
Other
Enumeration date
01/24/2017
Last updated
01/24/2017
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