Individual
JOERAY THAVONE MOAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
105 S SAN JOAQUIN ST, STOCKTON, CA 95202-3206
(209) 953-5466
Mailing address
105 S SAN JOAQUIN ST, STOCKTON, CA 95202-3206
(209) 953-5466
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
—
CA
175T00000X
Peer Specialist
Primary
MPSS-VTKGXI
CA
Other
Enumeration date
10/08/2025
Last updated
07/06/2026
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