Individual
KENNETH JASON HOLMES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
734 10TH AVE, SAN DIEGO, CA 92101-6502
(619) 239-4663
Mailing address
734 10TH AVE, SAN DIEGO, CA 92101-6502
(619) 239-4663
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
PT36002
CA
Other
Enumeration date
11/23/2011
Last updated
12/01/2011
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