Individual
FORMEKIA SHANTEL CHINN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
160 E VIRGINIA ST STE 100, SAN JOSE, CA 95112-5865
(408) 938-2113
(408) 579-6143
Mailing address
160 E VIRGINIA ST STE 100, SAN JOSE, CA 95112-5865
(408) 938-2113
(408) 579-6143
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
107302
CA
Other
Enumeration date
12/06/2023
Last updated
12/12/2023
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