Individual
DYANA INTHAVONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1768 MITCHELL RD STE 301, CERES, CA 95307-2156
(209) 353-4838
Mailing address
1768 MITCHELL RD STE 301, CERES, CA 95307-2156
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
265486
CA
Other
Enumeration date
07/17/2017
Last updated
01/11/2021
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