Individual
MARY LEONA FISHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
16/1964
Contact information
Practice address
151 KALMUS DR STE K3, COSTA MESA, CA 92626-5975
(714) 384-3870
Mailing address
115 PASEO DE LA SERENATA, SAN CLEMENTE, CA 92672-4351
(949) 842-0569
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
23452
CA
Other
Enumeration date
05/13/2013
Last updated
05/13/2013
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