Individual
LISA BAKKER JONES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2080 S E ST, SAN BERNARDINO, CA 92408-2773
(909) 388-9191
Mailing address
1432 E BERINGER DR, SAN JACINTO, CA 92583-5703
(909) 388-9191
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
28315
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1124100383
—
CA
Enumeration date
01/25/2016
Last updated
01/25/2016
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