Individual
MONICA FUENTES-RODRIGUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
7000 N MICHAEL CANLIS BLV, STOCKTON, CA 95206
(209) 468-4550
Mailing address
7000 N MICHAEL CANLIS BLV, STOCKTON, CA 95206
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
37558
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0
NA
—
Enumeration date
03/22/2019
Last updated
03/22/2019
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