Individual
SOUTSAKHONE LOUANGMILITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
220 S BARNWELL ST, OCEANSIDE, CA 92054-4507
(619) 246-0561
Mailing address
7598 CARRIE RIDGE WAY, SAN DIEGO, CA 92139-1333
(619) 536-9867
Taxonomy
Speciality
Code
Description
License number
State
3747A0650X
Attendant Care Provider
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
B9844883
DRIVER LICENSE
CA
Enumeration date
03/10/2022
Last updated
03/10/2022
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