Individual
TISHA JENYO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPT
Contact information
Practice address
850 E FOOTHILL BLVD, RIALTO, CA 92376-5230
(909) 421-4696
Mailing address
850 E FOOTHILL BLVD, RIALTO, CA 92376-5230
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
36906
CA
Other
Enumeration date
11/26/2019
Last updated
07/08/2020
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