Individual
ELIZABETH ANNE DEGRAVIO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
10904 LANDS END DR, STOCKTON, CA 95209-4289
(209) 986-5996
Mailing address
10904 LANDS END DR, STOCKTON, CA 95209-4289
(209) 986-5996
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
37500
CA
Other
Enumeration date
05/23/2014
Last updated
05/23/2014
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