Individual
JACK HUEYI CITLALIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2204 PACIFIC AVE N, LONG BEACH, WA 98631-3300
(360) 642-3787
Mailing address
2204 PACIFIC AVE N, LONG BEACH, WA 98631-3300
(541) 858-8170
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
11/07/2016
Last updated
04/03/2025
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