Individual
SISOUK RATTANACHANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1501 83RD AVE N, ST PETERSBURG, FL 33702-2851
(727) 579-1641
Mailing address
1501 83RD AVE N, ST PETERSBURG, FL 33702-2851
(727) 579-1641
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
FL
Other
Enumeration date
03/08/2016
Last updated
03/08/2016
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