Individual
KIMBERLEY MICHELE MICHAEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1212 N CALIFORNIA ST, STOCKTON, CA 95202-1552
(209) 468-0103
Mailing address
1212 N CALIFORNIA ST, STOCKTON, CA 95202-1552
(209) 468-0103
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
29086
CA
Other
Enumeration date
10/01/2021
Last updated
01/13/2024
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